Outpatient laparoscopic cholecystectomy in Hong Kong: patient acceptance

The authors performed a prospective evaluation of 60 Hong Kong Chinese patients with symptomatic gallstones and gallbladder polyps undergoing outpatient laparoscopic cholecystectomy in a regional hospital in Hong Kong from March 1996 to May 1998 to determine the feasibility, satisfaction, and acceptance of this procedure among Chinese patients. Patients with American Society of Anesthesiologists grade I and II gallstones or polyps were selected. Exclusion criteria included 1) history of upper abdominal operations, attacks of acute cholecystitis, cholangitis, or pancreatitis; 2) abnormal liver function; and 3) ultrasonographic evidence of contracted gallbladder, thickened gallbladder wall, dilated common bile duct, or common bile duct stones. Patients discharged at 5:00 PM on the day of cholecystectomy were defined as having undergone outpatient procedure. Patients were asked about procedure acceptance, rated on a scale of 1 to 10 (best), using a standardized questionnaire 4 weeks after operation. The study included 21 men and 39 women with mean age of 40.5 years (range, 27-59). There were no conversions to open procedures in the series. There were 6 (10%) unanticipated postoperative hospital admissions; all patients were discharged on the first postoperative day. Another patient was readmitted 3 days after operation because of a common bile duct stone. Overall patient acceptance of outpatient laparoscopic cholecystectomy was good, with a mean score of 8.6 of 10. Thirteen patients (22%) expressed dissatisfaction with being discharged earlier than they had expected, and 9 (15%) would have preferred inpatient care. Forty-eight patients (80%) resumed full daily activities by the first postoperative day; the remaining 12 did so by the end of the first week. Among the 44 working patients, only 4 (9%) resumed full duty within the first postoperative week; 29 (66%) did so by the second week and the remaining 11 (25%) returned to work after the third week. By selecting appropriate subjects, outpatient laparoscopic cholecystectomy is feasible and highly accepted among Hong Kong Chinese patients. Approximately one quarter of the patients preferred a longer postoperative stay or inpatient care.     

Outpatient laparoscopic cholecystectomy

OUTPATIENT LAPAROSCOPIC CHOLECYSTECTOMY: The laparoscopic technique is the procedure of choice for cholecystectomy. This procedure is done on ambulatory setting in the United States and Europe but no experience was reported in France. AIM OF THE STUDY: To report the organisation and results of our initial 100 consecutive patients operated for a laparoscopic cholecystectomy on an outpatient basis. PATIENTS AND METHODS: After assessment of the prevention of pain and nausea or vomiting after laparoscopic cholecystectomy on hospitalized patients, a prospective trial was done on our first 100 patients for outpatient laparoscopic cholecystectomy on routine basis. RESULTS: During the period, 27.4% of patients were entered on an ambulatory basis. 72% of patients did not need any medication post-operatively in the structure. 17 patients were admitted: in five cases, decision was done pre-operatively, one patient went back home against medical advising; in three cases, peroperatively, and in 10 cases postoperatively. Four patients were readmitted between the fifth and sixteenth post-operatoire day. CONCLUSION: An adequate organisation for day case surgery, a good selection of patients on medical, surgical and environmental criteria, simple procedures to prevent pain or nausea vomiting post-operatively allow use to assert that hospitalisation is unjustified for laparoscopic cholecystectomy in a quater of patients.     

Outpatient laparoscopic cholecystectomy

apd: 20 October 2000     

Outpatient laparoscopic laser cholecystectomy

Laparoscopic laser cholecystectomy has been performed clinically in the United States since 1988. After refinement of the technique, the procedure was offered on an outpatient basis. Eighty-three patients underwent laparoscopic laser cholecystectomy during the study period. Thirty-seven (45%) had the procedure as an outpatient. Younger patients were more suited for the outpatient procedure and those without previous surgery were more likely to have the procedure done as an outpatient. Weight, operating time, and gallbladder pathology were similar, although patients with acute inflammation of the gallbladder were more likely to require hospitalization. The primary reason for patient admission was patient preference.     

Five‐year experience of outpatient laparoscopic cholecystectomy in Hong Kong

Laparoscopic cholecystectomy (LC) is the standard procedure for the management of symptomatic gallstone disease. There are many studies that have evaluated LC in an outpatient setting and the results are promising. The aim of the present study was to evaluate our experience in outpatient laparoscopic cholecystectomy during a five‐year period. We recruited 135 consecutive patients with symptomatic gall bladder disease to undergo outpatient LC from February 2000 to May 2004. The overall successful outpatient rate was 93% and it gradually increased from 72.7% to 100% during the five‐year period. The overnight admission and conversion rate decreased in concordance with the increase in the outpatient LC rate. No major complications were encountered and the pain control was good. Opiate‐free anaesthetic protocol, involvement of an experienced anaesthesiologist and surgeon, good preoperative counselling and a well‐equipped day surgery centre are the prerequisites for the success of this new procedure. Nevertheless, one should be well prepared before the commencement of the program and potential disastrous complications cannot be overlooked.     

Outpatient laparoscopic cholecystectomy: a reality.

BACKGROUND: The author reports on his personal experience with outpatient laparoscopic cholecystectomy (LC), focusing on the main guidelines for preoperative and postoperative care and operating technique. METHODS: From January 1, 2000 to December 31, 2000, 71 laparoscopic cholecystectomies were performed on outpatients. The patients remained in the outpatient surgery center for 36 hours. In 4 cases, the operation was converted into laparotomy. Twenty patients remained in the hospital and were discharged 5 to 7 days later. Twelve were rehospitalized due to pathologies that could not be treated at home. RESULTS: In all 71 cases, a complete remission of the symptoms occurred, and none of the patients died either during the operation or during the postoperative period. Eighty percent of patients were treated in outpatient surgery centers. CONCLUSIONS: With clear guidelines, LC is a major surgical operation that can be performed in outpatient surgery centers without death or other major complications and with very good remission of symptoms.     

Outpatient laparoscopic cholecystectomy: patient and nursing perspective

Outpatient laparoscopic cholecystectomy has become nearly mandatory in the current health care economic environment. This study determined the opinions of patients and their nurses regarding disability and pain after laparoscopic cholecystectomy. Using a 14-point questionnaire, 32 consecutive patients who underwent inpatient LC were surveyed. The nurses caring for these patients were surveyed with a nine-point questionnaire. Seventy-one percent of patients believed that they could not have been discharged the day of surgery; the nurses reported that 81% of the patients could not have gone home. Nausea and vomiting were common. Pain was rated as 9 or 10 in 19% of patients. Nurses reported that 56% of postoperative patients were not receptive to discharge teaching. Morning (16) versus afternoon (16) procedures were not different. Successful programs of outpatient LC must: 1) ensure adequate home support because patient capability will be limited, 2) optimize pain control, 3) minimize nausea and vomiting, and 4) deliver patient education preoperatively.     

Suicidal burns in Hong Kong Chinese

There were 1063 acute burn patients admitted to the Burns Unit of Prince of Wales Hospital, Hong Kong, between March 1993 and February 1999. Eleven patients (1%) were burned due to attempted suicide. Seven were males and four were females, with a male:female ratio of 1.75:1. The median age was 38 years (range: 20-49 years) and the median extent of the burns was 55% total body surface area (range: 1-95%). Ten patients (90.9%) were self-incinerated and one patient attempted suicide by jumping into a hot bath. Seven patients (63.6%) suffered from severe smoke inhalation injury that required immediate intubation for ventilatory support. The average number of operations for the survivors was 3.7 (range: 0-8) and their median hospital stay was 42 days (range: 2-92 days). Four patients (36.4%) died from their injuries. Suicidal burns were more common among unemployed males with a history of psychiatric illness and substance abuse. Town gas (naphtha: a mixture of 49% hydrogen, 28.5% methane, 19.5% carbon dioxide and 3.0% carbon monoxide) was the most frequently used agent for self-immolation because it is probably the most convenient source of a fire accelerant in Hong Kong. Compared to the general burn population, this suicide group had a larger extent of burns, higher incidence of inhalation injury, required more operative treatment and longer hospital stay with a higher mortality rate.     

Outpatient laparoscopic cholecystectomy: experience of a nonovernight surgicenter

From April 1994 to September 1998, a total of 66 laparoscopic cholecystectomies were performed at the same-day freestanding Surgicenter of the Yankton Medical Clinic. All patients (ages 15 to 62 years; 91% women) were discharged the same day, and no patient required hospitalization despite two conversions to open cholecystectomy. Cholangiofluoroscopies were completed in 70% of the patients. Pathologic evaluation showed chronic cholecystitis in all patients except one, who also had acute disease. No patient was lost to follow-up, and 98% responded that they "would do it again." These results confirm the safety of laparoscopic cholecystectomy in selected patients in a low- and controlled-cost environment of a freestanding surgical facility. Interestingly, Medicare does not allow facility reimbursement for cholecystectomy in any nonovernight outpatient surgery center in South Dakota.     

Perioperative and rehabilitation outcome after lower-limb amputation in elderly Chinese patients in Hong Kong

PURPOSE: Major amputation of the lower limb is considered the last resort when limb salvage is impossible. The aim of this study is to determine the morbidity, mortality, and rehabilitation outcome of patients that underwent a lower-limb amputation. METHODS: A retrospective cohort study was conducted among 100 elderly patients who underwent a total of 120 lower-limb amputations in a regional hospital in Hong Kong from 1996 to 2001. RESULTS: The mean age of the amputees was 77.9 years; 58 were female. 95% of the amputations were performed because of infection with or without vascular compromise; 55 transfemoral and 60 transtibial amputations contributed 96% of the case mix. Some 43% of patients experienced early complications and 12% required re-amputation. The early (30-day) mortality rate was 15%. Only 55% of the amputees survived after 4 years. A 44% return-home rate was achieved. However, only 11% of the amputees could walk without help from other people. Although prostheses were issued to 42% of the survivors, compliance was only 53%; 24% of the survivors lost their remaining leg within 2 years. CONCLUSION: The outcome of major lower-extremity amputation remains poor. Efforts should be made to retain these limbs. When it is proven impossible, one should strive to preserve the knee joint whenever feasible.     

First single incision transumbilical laparoscopic nephrectomy in Hong Kong

Single port access procedure attempts to further enhance cosmetic benefits and reduce morbidity of minimally invasive surgery. A 47-year-old woman underwent a single incision transumbilical laparoscopic nephrectomy for her non-functioning left kidney due to a full staghorn stone complicated by recurrent symptomatic urinary tract infection. The operation was successfully completed with three transumbilical ports (12 mm, 5 mm and 5 mm). Flexible grasper was used to facilitate dissection. Both 10 mm and 5 mm lens were used, the latter being required when instruments larger than 5 mm needed to be accommodated. The ureter was divided between Hem-O-Lok clips, whereas the renal vessels were controlled by vascular Endo-GIA staplers. Specimen retrieval was made possible by connecting the three transumbilical ports. No extra-umbilical incision was made. To my knowledge, this is the first case of single incision transumbilical laparoscopic nephrectomy ever carried out in Hong Kong.     

Sex-based analysis of the outcome of laparoscopic cholecystectomy for acute cholecystitis

BACKGROUND: Complicated acute cholecystitis, for example when empyema or gangrene is present, is associated with increased postoperative morbidity and mortality rates. The aim of this study was to determine the correlation between sex, the severity of acute cholecystitis and the outcome of laparoscopic cholecystectomy. METHODS: Of 674 patients in whom laparoscopic cholecystectomy was attempted, 348 had chronic cholecystitis and 326 had acute cholecystitis. The medical records of the latter were reviewed retrospectively. RESULTS: The proportion of male patients significantly increased with the severity of cholecystitis: 37.4 per cent of those with chronic cholecystitis were men, compared with 44.4 per cent of those with uncomplicated acute cholecystitis and 57 per cent of those with complicated acute cholecystitis (P = 0.001). Multivariate analysis showed that advanced age (odds ratio 2.24; P = 0.004) and male sex (odds ratio 1.76; P = 0.029) independently predicted complicated acute cholecystitis. The conversion rate to open operation was 6.4 per cent in men and 5.9 per cent in women (P = 0.843). The postoperative complication rate was 10.3 and 8.2 per cent respectively (P = 0.528). CONCLUSION: Male sex was identified as a risk factor for more severe acute cholecystitis, but outcome for men after laparoscopic cholecystectomy was not significantly different from that for women.     

腹腔镜胆囊切除和保胆取石术治疗胆囊结石的前瞻和对照性研究

目的 比较5年来腹腔镜胆囊切除术（LC）和腹腔镜联合胆道镜保胆取石术（LCCC）治疗胆囊结石的疗效.方法 将400例胆囊结石患者,在知情同意的情况下分为LCCC组（200例）和LC组（200例）.对两组的手术时间、术后住院时间、住院费用、术后症状和结石复发等因素进行分析.结果 LCCC组与LC组比较,手术时间长[（53.6±15.2） min与（29.4±10.8） min,P＜0.05）];术后住院时间差异无统计学意义.两组术后随访5年,平均3.8年.正常饮食情况下,LCCC组无腹泻症状,LC组术后出现腹泻症状者110例（55%）,差异有统计学意义（P＜0.01）,患者必须服用低脂饮食以缓解腹泻症状.技术开展初期（3个月）,经复查B超发现LCCC组结石残留4例（2%）,复发结石4例（2%）.两组住院费用差异无统计学意义.结论 LCCC较LC手术时间稍长,术后住院时间无明显差异.保胆手术复发和结石残留率低,无胆囊切除后的腹泻症状.保胆手术保留了患者的器官,值得进一步探索.     

Outpatient laparoscopic cholecystectomy: home visit versus telephone follow-up.

OBJECTIVES: To investigate the post-discharge follow-up required for patients who have undergone laparoscopic cholecystectomy on an outpatient basis and to determine if there was a significant difference in mean concern scores and satisfaction level of patients followed up by a home visit versus a telephone call. DESIGN: Prospective 2-group comparison. SETTING: A 221-bed acute care community hospital in western Canada. PATIENTS: One hundred and forty-nine patients who had undergone laparoscopic cholecystectomy and agreed to be discharged on the day of operation. INTERVENTIONS: Subjects were systematically allocated to receive either a home visit (HV, n = 72) or a telephone call (TC, n = 77) from a registered nurse on the evening of operation. During the follow-up, patient concerns were self-rated, interventions provided by the nurse were recorded, and nurses' perceptions of the need for the home visit were reported. A 48-hour telephone survey was used to determine patient satisfaction. OUTCOME MEASURES: Patient concern scores, patient satisfaction with follow-up, readmission rates and use of emergency room services within 30 days of operation. RESULTS: Subjects in the TC group had a significantly lower mean concern score (p < 0.001) and were significantly more satisfied with their follow-up (p = 0.034) than those in the HV group. Nurses perceived that 75% of the home visits were not necessary. Readmission rate was less than 1% (1 HV) and use of emergency room services was 6% (3 HV, 6 TC). CONCLUSIONS: Telephone contact is an acceptable method of follow-up for patients who have undergone outpatient laparoscopic cholecystectomy. The call should be made later in the evening on the day of operation or the next morning.     

Intracranial tumours among Chinese in Hong Kong

Fifty-six surgical biopsies of intracranial tumours were seen within two years in a newly established neurosurgical unit in Hong Kong. Among the 52 cases of primary intracranial tumours, glioma is the most common, followed by meningioma and pituitary tumour. This is similar to findings in Caucasians. When the distribution of glioma is analyzed, Chinese, or possibly Orientals, have a much higher incidence of ependymoma and pinealoma than do Caucasians. Similar findings are found in other Chinese series reported in the literature.