Day-case laparoscopic cholecystectomy in obese patients: safety and feasibility

Objectives To assess the outcomes of day-case laparoscopic cholecystectomy (LC) in different BMI groups with stress on the safety and success of the procedure in patients with high BMI. Patients and methods Included patients have their LC in Departments of Surgery at Minia University Hospital and Misr University for Science and Technology Hospital over 2 years (2014 and 2015). Patients with gallbladder cancer or active malignancy were excluded. Comorbidities and American Society of Anesthesiologists (ASA) grading were recorded. According to BMI, patients were divided into six groups: underweight, normal weight, overweight, obese class I, obese class II, and obese class III. Results A total of 286 patients were included. ASA grading of patients yielded ASA I (23.4%), ASA II (56.7%), and ASA III (19.9%). Magnetic resonance cholangiopancreatography was performed in 16.4% of patients followed by endoscopic retrograde cholangiopancreatography with clearance of common bile duct. Intraoperative bile leak was observed in 0.7% of patients treated by endoscopic retrograde cholangiopancreatography and stenting. Open conversion happened in 2.8% of patients. Mean hospital stay was 1.13+0.06 days. Rate of overnight stay was increased in some cases owing to conversion to open procedure, drain insertion, wound infection, and intraperitoneal collection. Readmission happened for 1.7% of patients within 30 days of their operation with pain or nausea. Port-site bleeding was recorded in one (0.3%) patient. Conclusion Day-case LC is a safe and feasible treatment in patients with high BMI, resulting in cost reduction owing to shortening of hospital stay and reduction in the risk of nosocomial infections and thromboembolism.