Masood Raza Khan, Saeed Al Ghamdi, Mohammad Fawzy Mostafa Nasser, Medhat Mustafa, Murad Sami, Saleem Abdul Sattar.
Day case laparoscopic cholecystectomy: an experience at King Abdullah Hospital, Bisha, Kingdom of Saudi Arabia.
Pak J Surg Jan ;28(4):251-5.

Background: To achieve economy, effi ciency and eff ective use of resources Ministry of Health, Kingdom of Saudi Arabia directed for development of day case Surgery (laparoscopic surgery unit) in our Hospital. Th e objective of this study were to determine the safety and feasibility of Day case Laparoscopic Cholecystectomy, unplanned admission rate, identify reasons for unplanned admissions and re-admissions aft er discharge, and to explore how to improve the same day discharge rate. Design: Retrospective descriptive study. Sett ing and Duration: Th is study is done in King Abdullah Hospital Bisha, KSA, from July 2010 to June 2012. Methodology: Patients selected from out-patient clinic who presented with symptoms consistent with biliary colic and an Ultrasound scan confi rmed Gallstones. Patients admitt ed with cholecystitis which sett led aft er conservative treatment were also considered for day-case surgery aft er six weeks of discharge. Other criteria set for Day case LC was patients less than 55 years of age and graded I and II on the ASA physical status score, living within 50 km to Hospital and had arrangements for a return to hospital in case of problem. At discharge they were advised to come in ER at any time they feel signifi cant pain vomiting or other complains. Results: 62% of the patient fi t into eligibility criteria, 224 patients, and were found suitable for Day case LC. Th e commonest cause for rejection was that the patient lived out of the defi ned area (20%). Altogether 88.8%(199)patients were discharged within eight hours of surgery. Th e reasons for failure to discharge were abdominal drain in 7, vomiting in 6, conversion to open surgery in 5 and late operation start time in 6 patients, one patient admitt ed as she developed SVT(paroxysmal supraventricular tachecardia. 5 patients (2.2%) were readmitt ed aft er discharge.3 due to unusual pain and vomiting, one patient admitt ed with mild subhepatic collection and one patient developed obstructive juandice due to CBD stone. None of the patients developed surgery related complications and later on discharged with full recovery. Conclusions: Day case LC is safe, feasible, and has potential benefi ts for health care delivery system to patients. We can improve our Day case LC services and reduce admission and readmission rate by strict adherence to guidelines/protocols made for Day case LC and by bett er cooperation with anaesthesia department.

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