Day case laparoscopic cholecystectomy at Kilimanjaro Christian Medical Centre, Tanzania
Journal – Surgical Endoscopy
Publication date – Sep – 2020
Authors – Imogen Cullen, Fadlo Shaban, Oroog Ali, Matthew Breckons, Kondo Chilonga, Daudi Wapalila, Jamil Suleilman, Mercy Elinisa, Bronwyn Woodburn, Richard Walker & Liam Horgan
Keywords – Ambulatory surgery; Day case; Global surgery; Laparoscopic cholecystectomy; Low- and middle-income countries; Tanzania
Open access – Yes
Speciality – General surgery
World region Eastern Africa
Language – English
Submitted to the One Surgery Index on October 18, 2020 at 3:53 pm
Introduction: The Lancet Commission on Global Surgery has promoted the case for safe, affordable surgical care in low- and middle-income countries (LMICs). In 2017, Kilimanjaro Christian Medical Centre (KCMC) in Tanzania introduced a day case laparoscopic cholecystectomy (DCLC) service, the first of its kind in Sub-Saharan Africa (SSA). We aimed to evaluate this novel service in terms of safety, feasibility and acceptability by patients and staff.
Methods: This study used mixed methods and was split into two stages. In stage 1, we reviewed records of all laparoscopic cholecystectomies (LCs) comparing day cases and admissions. These patients were followed up with a telephone questionnaire to investigate complication rates and receive service feedback. Stage 2 consisted of semi-structured interviews with staff exploring the challenges KCMC faced in implementing DCLC.
Results: 147 laparoscopic cholecystectomies were completed: 109 were planned for DCLC, 82 (75.2%) of which were successful, whilst 27 (24.8%) patients were admitted. No variables significantly predicted unplanned admission, the commonest causes for which were pain and nausea. In the DCLC group there was 1 readmission. 62 patients answered the follow up questionnaire, 60 (97%) of which were satisfied with the service. Stage 2 interviews suggested staff to be motivated for DCLC but revealed poor organisation of the day case pathway.
Conclusion: High rates of DCLC combined with low rates of complications and readmission suggests DCLC is feasible at KCMC. However, staff interviews alluded to administrative problems preventing KCMC from reaching its full DCLC potential. A dedicated day case surgery unit would address most of these problems.
OSI Number – 20676
PMID – 32875414