Day-case laparoscopic cholecystectomy

To assess the safety and feasibility of laparoscopic cholecystectomy as a day-case procedure. All consecutive patients who were admitted to the day-surgery unit for laparoscopic cholecystectomy at the Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia from July 2009 to June 2013 were considered for this retrospective study. The medical records were reviewed for age, gender, presenting symptoms, laboratory findings, imaging studies, American Society of Anesthesiology [ASA] grade, anesthesia, conversion to open cholecystectomy, complications, the operating surgeons, pain management, nausea, and vomiting, overnight stay, readmission, morbidity, mortality, and outpatient follow up were collected and analyzed. A total of 487 patients underwent laparoscopic cholecystectomy as a day case [ASA I=316, ASA II=171]. Surgery was performed by high surgical trainees [HSTs] [n=417] and consultants [n=70] with conversion to open cholecystectomy in 4 patients. Twenty-two [5%] patients were admitted for overnight stay for different reasons, while 465 [95%] patients were discharged before 8 pm. Two patients [0.4 %] were re-admitted to the hospital due to abdominal pain. Five patients developed umbilical port site infection [1%]. A total of 443 patients were satisfied [97%], while 14 [3%] were unsatisfied. There was no mortality or intra-abdominal septic collection. Day-case laparoscopic cholecystectomy is safe and feasible with optimal patient selection, education, and planned postoperative antiemetic and analgesia management

Early endoscopic retrograde cholangiopancreatography in mild gallstone pancreatitis with deranged liver function test. A 7-year experience in central Saudi Arabia

To determine the use of liver function tests [LFTs] as a selection tool for preoperative endoscopic retrograde cholangiopancreatography [ERCP] in patients with mild gallstone pancreatitis. All patients admitted with mild gallstone pancreatitis with deranged LFTs in King Saud Medical City, Riyadh, Kingdom of Saudi Arabia between January 2006 and February 2013 were studied retrospectively. Patients' demography, symptoms, laboratory values, imaging studies, ERCP findings, complications and its treatment, surgical intervention, intraoperative and postoperative findings, mortality, and outpatient follow up were collected and analyzed. A total of 245 patients were admitted as mild gallstone pancreatitis with admission day deranged LFTs. Pre-operative ERCP was performed in 74 patients based on admission day LFTs [Group A]. Endoscopic retrograde cholangiopancreatography was normal in 65 patients, revealed stones in 5, and sludge in 4 patients. Six patients developed ERCP complications. Endoscopic retrograde cholangiopancreatography was deferred in 171 patients [Group B] until the LFTs were repeated in 3-4 days. Liver function tests remained persistently high in 8 patients. They were submitted to preoperative ERCP, which revealed stones [n=5] and sludge [n=3]. Patients with normalized LFTs [n=163] were not submitted to ERCP. Three of them developed gallstone related complications. Patients admitted with predicted mild gallstone pancreatitis, deranged LFTs, and no evidence of cholangitis should not be submitted to ERCP unless a repeat LFT within 3-4 days shows persistently deranged LFTs. This will reduce unnecessary ERCP and its complications