Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice.

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.

Ensuring safe surgical care across resource settings via surgical outcomes data & quality improvement initiatives.

Staggering statistics regarding the global burden of disease due to lack of surgical care worldwide has been gaining attention in the global health literature over the last 10 years. The Lancet Commission on Global Surgery reported that 16.9 million lives were lost due to an absence of surgical care in 2010, equivalent to 33% of all deaths worldwide. Although data from low- and middle-income countries (LMICs) are limited, recent investigations, such as the African Surgical Outcomes Study, highlight that despite operating on low risk patients, there is increased postoperative mortality in LMICs versus higher-resource settings, a majority of which occur secondary to seemingly preventable complications like surgical site infections. We propose that implementing creative, low-cost surgical outcomes monitoring and select quality improvement systems proven effective in high-income countries, such as surgical infection prevention programs and safety checklists, can enhance the delivery of safe surgical care in existing LMIC surgical systems. While efforts to initiate and expand surgical access and capacity continues to deserve attention in the global health community, here we advocate for creative modifications to current service structures, such as promoting a culture of safety, employing technology and mobile health (mHealth) for patient data collection and follow-up, and harnessing partnerships for information sharing, to create a framework for improving morbidity and mortality in responsible, scalable, and sustainable ways.

Single incision laparoscopic surgery from a caribbean perspective.

Conventional laparoscopy with multiple ports has recently gained a strong foothold in the Caribbean, but single incision laparoscopic surgery (SILS) has lagged behind. In this paper, we compare the data on SILS and conventional multi-port laparoscopy in the English-speaking Caribbean.