Day case laparoscopic cholecystectomy at Kilimanjaro Christian Medical Centre, Tanzania
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and Other Interventional Techniques
Day case laparoscopic cholecystectomy at Kilimanjaro Christian Medical Centre, Tanzania Imogen Cullen1,5 · Fadlo Shaban2 · Oroog Ali2 · Matthew Breckons3 · Kondo Chilonga4 · Daudi Wapalila4 · Jamil Suleilman4 · Mercy Elinisa4 · Bronwyn Woodburn1 · Richard Walker2,3 · Liam Horgan2 Received: 22 April 2020 / Accepted: 17 August 2020 © The Author(s) 2020
Abstract 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. Keywords Global surgery · Laparoscopic cholecystectomy · Day case · Low- and middle-income countries · Ambulatory surgery · Tanzania
A mixed methods study reviewing the first documented day case laparoscopic cholecystectomy service in sub-Saharan Africa. This study analyses the services’ successes so far and investigates the challenges faced when implementing day case surgery in a low resource setting. * Imogen Cullen [email protected] 1
Newcastle University, Newcastle upon Tyne, United Kingdom
2
Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
3
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
4
Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
5
The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
A third of the world’s disease burden comprises surgical conditio
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