Mini-laparotomy cholecystectomy: same day discharge.

To the Editor: We read the article on same day discharge after mini-laparotomy cholecystectomy (MLC) with great interest. The article has stressed many valid concepts regarding MLC. We would like to share our experience at Sawai Man Singh Hospital, Jaipur. The authors’ unit has been performing MLC for the past 6 years, and the case series includes 78 patients (52 women, 26 men). Mean age of the patients was 51.6 years. Forty-two (53.8%) of the 78 patients were operated on under general anesthesia, and the rest had epidural anesthesia. Thirtysix out of 78 MLCs were performed by the chief resident and the rest by the faculty. The mean operating time was 96.4 minutes. Mean hospital stay was 3.2 days. The major postoperative complications included biliary leak in 3.8% (3/78) patients, common bile duct injury in 2.5% (2/78) patients and right upper quadrant pain in 94% (72/76) of patients. Incidence of postoperative pain after MLC in comparison to open cholecystectomy has been debated, and the majority of our patients (66.6%; 52/78) had an extended hospital stay due to right upper quadrant pain. The literature fails to explain the excessive pain, which to our knowledge is due to prolonged and excessive retraction during MLC to gain adequate access to Calot’s triangle, leading to more tissue trauma. We feel that MLC, although cosmetically superior to open cholecystectomy, is not an alternative to laparoscopic cholecystectomy as day surgery. Hemant Sharma Basic Surgical Trainee Department of Surgery Whiston Hospital Prescot, Merseyside, UK Department of Surgery Sawai Man Singh Medical College Hospital Jaipur, India Research Associate to Prof. N.S. Shekhawat