INTRODUCTION: Day-case laparoscopic cholecystectomy (DCLC) is not universally adopted and its use is limited to patients selected by non-standardized criteria. Since laparoscopic cholecystectomy is considered technically more difficult in obese patients, a high body mass index (BMI) is often considered an exclusion criterion for DCLC. The aim of this research is to define the feasibility and safety of day case laparoscopic cholecystectomy in obese patients. PRESENTATION OF CASE: Data from 730 consecutive patients preoperatively considered suitable for DCLC were analysed. BMI was not considered as parameter of selection and patients were divided in two groups (Obese, 294; Non-obese, 436) according to a BMI ≥ 30 or < 30 kg/m2, respectively. Outcomes measured were morbidity, open conversion rates, hospitalization rates, length of hospital stay and readmission. Overall morbidity and open conversion rates were similar in both groups. No significant differences were observed among the two groups in terms of hospitalization rates (p 0.0533), early complications (p 0.2536), length of hospital stay (p 0.3780) and readmission rates (p 0.4286). DISCUSSION: Day case laparoscopic cholecystectomy is a widely used surgical technique despite not routinely used in every health system. However, many factors related to the patient and procedure, as well as the expertise of surgical-anesthesiologist team, can influence the feasibility of DCLC. Moreover a well-organized health community system is necessary to protect and follow the patients up. Our readmission and complication rates showed how a day case laparoscopic cholecystectomy, if performed in the right setting, is a safe procedure also for patient with a raised BMI. We enrolled a large population of patients and the statistical analysis demonstrated no significant differences among the obese and non-obese patient regarding the primary and secondary endpoints. CONCLUSIONS: DCLC is a safe and effective procedure in obese patients with morbidity, hospital admission and readmission rates similar to those observed in non-obese patients.
INTRODUCTION: Day-case laparoscopic cholecystectomy (DCLC) is not universally adopted and its use is limited to patients selected by non-standardized criteria. Since laparoscopic cholecystectomy is considered technically more difficult in obesepatients, a high body mass index (BMI) is often considered an exclusion criterion for DCLC. The aim of this research is to define the feasibility and safety of day case laparoscopic cholecystectomy in obesepatients. PRESENTATION OF CASE: Data from 730 consecutive patients preoperatively considered suitable for DCLC were analysed. BMI was not considered as parameter of selection and patients were divided in two groups (Obese, 294; Non-obese, 436) according to a BMI ≥ 30 or < 30 kg/m2, respectively. Outcomes measured were morbidity, open conversion rates, hospitalization rates, length of hospital stay and readmission. Overall morbidity and open conversion rates were similar in both groups. No significant differences were observed among the two groups in terms of hospitalization rates (p 0.0533), early complications (p 0.2536), length of hospital stay (p 0.3780) and readmission rates (p 0.4286). DISCUSSION: Day case laparoscopic cholecystectomy is a widely used surgical technique despite not routinely used in every health system. However, many factors related to the patient and procedure, as well as the expertise of surgical-anesthesiologist team, can influence the feasibility of DCLC. Moreover a well-organized health community system is necessary to protect and follow the patients up. Our readmission and complication rates showed how a day case laparoscopic cholecystectomy, if performed in the right setting, is a safe procedure also for patient with a raised BMI. We enrolled a large population of patients and the statistical analysis demonstrated no significant differences among the obese and non-obesepatient regarding the primary and secondary endpoints. CONCLUSIONS: DCLC is a safe and effective procedure in obesepatients with morbidity, hospital admission and readmission rates similar to those observed in non-obesepatients.
Authors: Malcolm H W Mak; Woon Ling Chew; Sameer P Junnarkar; Winston W L Woon; Jee-Keem Low; Terence C W Huey; Vishalkumar G Shelat Journal: Ann Hepatobiliary Pancreat Surg Date: 2019-02-28
Authors: Júlio Cezar Uili Coelho; Giuliano Ohde Dalledone; Eduardo Lopes Martins Filho; Eduardo José Brommelstroet Ramos; Marco Aurélio Roeder da Costa; Omar O H M de Loyola E Silva Journal: JSLS Date: 2019 Apr-Jun Impact factor: 2.172