Background: Laparoscopic cholecystectomy has been performed as outpatient procedure for many years. Few studies have been conducted with primary focus on patient acceptance and preferences in terms of safety and satisfaction. We tried to explore its feasibility in otherwise healthy individuals undergoing laparoscopic cholecystectomy.
Methods: Data from 250 patients with cholelithiasis who underwent laparoscopic cholecystectomy in BIRDEM General Hospital from April 2017 to June 2018 as ambulatory surgery (hospital stay d”23 Hours) with or without overnight stay were analyzed. Complications, admissions and readmissions, patient satisfaction and treatment expenditure were assessed.
Results: Mean duration of hospital stay was 17.3 hours. Two patients had complications (deep port site infection) on 5th post-operative day after surgery. Only 2.4% patients required readmission while 9.2% patients had unplanned admission. Seventy six point four percent patients were highly satisfied with the procedure. Treatment cost was about 15% lower than routine inpatient operation.
Conclusion: Laparoscopic cholecystectomy can be performed as an outpatient procedure with a low rate of complications and admissions/readmissions. Patient acceptance in terms of satisfaction is high.
Birdem Med J 2019; 9(2): 157-161
Background and objectives: Laparoscopic surgery is normally performed under general anesthesia (GA), but regional techniques like epidural or subarachnoid block (SAB) have been found beneficial in patients having associated major medical problems. In selected cases, it can be a safe alternative to GA. Hence, the present study was conducted to explore the safety and feasibility of SAB in otherwise healthy individuals undergoing laparoscopic cholecystectomy.
Methods: Forty patients undergoing elective laparoscopic cholecystectomy and fulfilling specific inclusion criteria were included in the study. All patients received a segmental (L2-L3 injection) SAB with 3 ml (0.5%) of bupivacaine and 25 microgram of fentanyl. Laparoscopic cholecystectomy was done by standard 4 port technique. Intra-abdominal pressure was kept low at 9-10 mm Hg using CO2 pneumoperitoneum. Patients were followed up at 30 minutes, 4 hours, at the time of discharge and on day 7 after operation. Any unwanted voluntary or involuntary movement or exaggerated diaphragmatic excursion during the operation was monitored. Operation time, operating room (OR) occupancy time, hospital stay, post-operative pain, analgesic requirement, nausea, vomiting, headache, right shoulder pain, wound-related complications and patient satisfaction were recorded.
Results: SAB was effective for surgery in all 40 patients. Two patients required conversion to general anesthesia for persisting low oxygen saturation. Hypotension was recorded in 23.7% patients while 10.5% experienced right shoulder pain. Average operating time was 37.3 minutes (21 - 77 minutes). Awkward movement and exaggerated respiratory excursion was noted in 23.7% and 18.4% cases respectively. Only two cases had to undergo (conversion to) GA. Mean period of hospital stay was 29.3 hours. No incidence of any major complication occurred.
Conclusion: This study showed that SAB could be used successfully and effectively for laparoscopic cholecystectomy in healthy patients and may be a safe alternative to GA.
IMC J Med Sci 2019; 13(1): 006
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.