Day case laparoscopic cholecystectomy is safe and feasible: a case controlled study

Abstract

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.

Patients and 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).

Conclusion: 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.