title: Day Care vs Overnight Stay after Laparoscopic Cholecystectomy even with Co-morbidity and a Possible Second Surgery: A Patient's Choice.
abstract: BACKGROUND
  Laparoscopic Cholecystectomy (LC) has become the gold standard for symptomatic gall stone disease. It is being practiced as a day care procedure in healthy individuals in American Society of Anaesthesialogists (ASA) grade I and II. It is not yet established in presence of co-morbidity and when a second surgery is added. In most of the study, patient's choice and the psycho-social factors were not considered in deciding the day care procedure.
  
  
  OBJECTIVE
  To find the safety of LC and a second surgery as day care in presence of compensated co-morbidity. To study the choice of the patient whether to stay in hospital or go home after declaring them fit for day care.
  
  
  METHODS
  All the patients of symptomatic cholelithiasis with co-morbidity and associations were evaluated and made uncompromising for elective surgery. All the LC were done at 8mmHg CO2peumo-peritoneal pressure using harmonic scalpel as the energy source for dissection of gall bladder from the liver bed. Cases with conversion and placement of drain were excluded.
  
  
  RESULTS
  A total of 1029 out of 1042 patients was included from Jan 2005 to Jan 2015. The age range was 38 to 91years (mean 44.65, SD 14.15). There were 634 females and 395 males. A total of 121(11.7%) of them had co-morbidity and associations. A total of 72(7%) had undergone a second surgery. Only 0.8% had real day care. A total of 95.7% had overnight stay even after fulfilling all the criteria. Only 0.2% needed re-admission in 30 days and one required intervention.
  
  
  CONCLUSIONS
  Patients like to stay over night in the hospital even if found fit for day care after LC. Overnight stay makes them happy, psycho-socially confident in developing nation and best suited for all patients including co-morbidity.
authors.affiliation: Professor, Department of Surgery, Vydehi Institute of Medical Sciences , Bengaluru, Karnataka, India .
authors.forename: Aswini Kumar
authors.initials: AK
authors.lastname: Pujahari
keywords: Gallstones; Lap chole; Second surgery