Day case laparoscopic cholecystectomy is safe and feasible: a case controlled study.
BACKGROUND
Day case laparoscopic cholecystectomy (DC-LC) is being practised in the USA and at sporadic centres in the UK including our department. The aim was to evaluate the admission rate after DC-LC.


METHODS
Prospectively collected data was analysed retrospectively. The case notes of all patients were retrieved from the medical records and reviewed individually. Inclusion criteria for DC-LC were cholelithiasis, non-acute cholecystitis, ASA I-III and informed consent. Standard laparoscopic cholecystectomy was performed. All patients had anti-DVT prophylaxis (pneumatic compression and enoxaparin), per-operative antibiotic, oro-gastric tube, paracetamol suppository and local anaesthetic to all wounds. They were discharged the same day. The end point was 6-week follow-up (86% overall).


RESULTS
Over a 32-month period, 164 consecutive patients with symptomatic cholelithiasis and ASA score of III or less were included. M:F was 1:5 and median age 45y. There were two conversions. The direct admission rate (DAR) was 26/164 (14%). The indication for direct admission included observation alone (7/26), wound pain (6/26), nausea (3/26), suction drain (2/26) and operation in the afternoon (2/26). Six (3.6%) required re-admission. One had a cystic artery pseudo-aneurysm presenting with colonic bleeding and another with an injury to CBD. One had post-operative mild pancreatitis and three had wound pain and bruising. Fourteen out of 41 were admitted in the >55y age group compared to 12/123 from <55y age group (p=0.00054).


CONCLUSIONS
DC-LC is safe and feasible in non-acute patients with symptomatic cholelithiasis. Over-55y age group had a higher chance of admission, mainly due to caution.
Department of Surgery, Causeway Hospital, Newbridge Road, Coleraine BT52 1HS, Northern Ireland, UK. munirrathore@doctors.org.uk <munirrathore@doctors.org.uk>
M A
MA
Rathore
S I H
SI
Andrabi
M
M
Mansha
M G
MG
Brown
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D016022:Case-Control Studies; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery*; D016001:Confidence Intervals; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome