Department of General Surgery, Centre for Advanced Laparoscopic Surgery (CALS), Digestive Disease Centre, Tan Tock Seng Hospital, Singapore.
HPB (Oxford). 2008;10(6):433-8. doi: 10.1080/13651820802392312.
Day-Case laparoscopic cholecystectomy (LC) is practiced in many countries. However, this has yet to be widely accepted in Singapore. This study aims to determine the potential success rate of day-case LC in our institution.
We retrospectively assessed the proportion of our Ambulatory Surgery 23 hour (AS23) LC patients that met discharge criteria. Our proposed same-day discharge criteria include minimal pain, ability to tolerate feeds, ambulate independently and void spontaneously after 6-8 hours of monitoring.
From January 2005 to December 2006, of 405 patients listed for elective LC, 84% of patients were admitted to our AS23 ward. Patients with previous biliary sepsis or pancreatitis or who need laparoscopic common bile duct exploration (LCBDE) were included. The other 66 were admitted as inpatient. Forty-one of them were admitted due to conversion. A history of cholecystitis or cholangitis was a significant predictor of conversion to open surgery (OR=5.73 and 5.74 respectively, p<0.001). Of the 339 patients, 66% of them fulfilled all four criteria within eight hours of monitoring. Therefore, based on an intention-to-treat analysis, 51.2% fulfilled all four criteria and could potentially be discharged the same day. No predictor for failure was identified, including presence of co-morbidities, duration of operation, surgeon's grade and additional procedures like LCBDE.
Using our current inclusion criteria, we projected a success rate of at least 50% with the implementation of day-case LC. With the attendant advantages of cost savings and reduced resource utilization, it is therefore worthwhile to start it in Singapore.
日间腹腔镜胆囊切除术（LC）在许多国家得到实践。然而，在新加坡，这种手术方式尚未被广泛接受。本研究旨在确定我们机构日间 LC 的潜在成功率。
我们回顾性评估了我们的日间手术 23 小时（AS23）LC 患者中符合出院标准的比例。我们提出的当天出院标准包括轻微疼痛、能够耐受喂养、独立行走和在监测 6-8 小时后自主排尿。
从 2005 年 1 月至 2006 年 12 月，在 405 名接受择期 LC 的患者中，84%的患者被收入我们的 AS23 病房。包括既往胆道感染或胰腺炎或需要腹腔镜胆总管探查术（LCBDE）的患者。其他 66 名患者则作为住院患者入院。其中 41 名因转为开腹手术而入院。胆囊炎或胆管炎的病史是转为开放手术的显著预测因素（OR=5.73 和 5.74，均<0.001）。在 339 名患者中，66%的患者在监测 8 小时内满足所有四项标准。因此，根据意向治疗分析，51.2%的患者满足所有四项标准，有潜力当天出院。未发现任何失败的预测因素，包括合并症、手术持续时间、外科医生的级别以及像 LCBDE 这样的附加手术。
使用我们目前的纳入标准，我们预计实施日间 LC 的成功率至少为 50%。日间 LC 具有节省成本和减少资源利用的优势，因此在新加坡开展是值得的。
