It is not uncommon to see an abdominal ultrasonogram report suggesting stones in the gall bladder when you visit your doctor for pain in the upper abdomen or indigsetion or chronic gas. Stones in the gall bladder is a more serious condition than stones in the kidneys. The GB stones can cause infection in the gall bladder presenting with severe pain abdomen, can also cause jaundice by blocking the bile passage into the intestine and rarely a near fatal condition called acute pancreatitis by blocking the mouth of the pancreatic duct.
There is no medical treatment for gall bladder stones and these patients will require laparoscopic removal of the gall bladder along with the stones.
This surgery is performed as a day care procedure where in the patient checks into the hospital at 5.00am. Surgery is done at 6.00am and the patient is discharged at 2.00pm. Effectively the patient is in the hospital for about 6 hours. They walk back home and will take a normal dinner that night. Pain killer medications are given for relief of pain if any.. These patients start their routine normal activity the day following surgery. In the last 100 such operations we performed ,we had no problems with any patient and none of them have been re-admitted to the hopital. So I believe that laparoscopic gall bladder remoban can be safely operated on a day care basis and there is absolutely no need for the patient to saty in the hospital overnight
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Like most other areas,healthcare sector too is driven by the market forces but I think it is also the public that makes certain assumptions and decisions for themselves like smaller, newer, scarless,bloodless,painless, shorter stay etc in hospitals the better, who most of the time are cleverly misled.Honesty surely is a very rare virtue in todays world. But day care surgeries are safely practiced in our hospitals here even in indicated surgeries. Thanks
Comparing US with India is like comparing oranges with apples. Even in the US a lot of unindicated surgical work is being done just to add numbers and deliver profits to the hospital. Only a select few surgeons practice surgery honestly. Recently a national news channel had unearthed a nexus between radiology clinics and hospitals. The radiology clinics give a false positive report of gall stones. The patient is convinced to undergo removal at the earliest. As the patient is heavily coverd by insurance, he does not mind. Effectively a normal gall bladder is removed. So obviously the procedure has to go smoothly. This adds numbers to the surgeon's portfolio as well as fetches business to the hospital. Another area where this is happening is for hiatus hernia and reflux disease. A disease which is not serious enough to warrant surgical intervention in about 90% of cases has suddenly taken the centrestage in all conferences wherein surgeons claim to have very big personal series of operated cases.Adding frills to surgical procedures has become a marketing strategy to woo more patients. It is advertised on buses, trains and cable channels as is for cardiological procedures.
Day care surgeries are very common in the United States. Infact most laparoscopic surgeries are done on a day care basis here. Rarely do the patients stay overnight. In very few cases where the patients pain is uncontrolled or have difficult extubation do they have to stay back. I think with well experienced hands intraoperatively, proper post op recovery, good preop and post discharge education ,most patient do pretty well. An early follow up appointment is always a must for these patients. Regards.
Sending patients home on the same day of surgery sounds an exageration. All patients cannot be the same. If the procedure goes through smoothly that is there is no problem with the dissection then it would be ok. But that does'nt happen everytime. If there is extensive dissection or some amount of oozing then it takes time for the abdomen to settle down. The amount of pain despite using the best pain killers still is significant warranting rest. Under no circumstances can such a patient restart his daily routine the next day. It is a safe practice to keep the patient for a day or two till he passses flatus. Disastrous complications are taking place all over the country with respect to lap procedures but theses are never reported. It is always safe to be defensive and alert rather than be highhanded and heroic.