Laparoscopic cholecystectomy in an ambulatory setting - initial experience in Croatia

Background/Aims: The purpose of this study was to discover if ambulatory laparoscopic cholecystectomy is feasible in our environment and to determine the factors which will predict its success. Methodology: From November 12th 2002, to February 25th 2005 one hundred and fifty patients were admitted to our surgical ward of the General Hospital in Bjelovar due to cholelithiasis or biliary colic. Patients were unselected. Six to eight hours after the surgery we rated the ability of the patients to be discharged from the hospital (although they weren't discharged). Results: The research has shown that 61% of the patients were eligible for ambulatory procedure. Among ultrasonographic attributes the most significant independent predictive factor of potential complications, prolongation of the procedure and ineligibility of the patient for the ambulatory laparoscopic cholecystectomy in our study was the thickened wall of the gallbladder. Among non-ultrasound preoperative attributes, the most important are the anamnestic data of prior cholecystitis and ASA classification. Pain was the most common reason why the patients were classified as non-candidates (36.6%). In the second place (25.4%) was the negative subjective patient's judgement to be discharged when all objective parameters were good. Conclusions: LC is also feasible in our environment but the patient's own motivation is the key factor in our situation.