Laparoscopic cholecystectomy in a rural family practice: The Vivian, LA, experience
Objective To evaluate the feasibility of family physicians safely and effectively performing laparoscopic cholecystectomy in a community hospital, as compared with published case series in the surgical literature.
Methods A case series of self-referred patients from the surrounding community to a family physician–run community hospital in rural Louisiana from 1992 to 2001. The cohort represented a consecutive, volunteer convenience sample of self-referred patients requiring laparoscopic cholecystectomy, aged 18 to 89 years, of diverse demographic background. Main outcome measures included mortality, complication, reoperation, and conversion to open procedure rates.
Results One hundred eight patients have undergone laparoscopic cholecystectomy; there have been no deaths; 2 cases were converted to open procedures; no common bile duct injuries, postoperative complications, or long-term complications.
Conclusion The outcomes of this series of laparoscopic cholecystectomy were similar to those of other case series and met published standards of care.
Nonetheless, several limitations are worth noting. Successful performance of this procedure requires focused training, discipline, skills and technology, and ongoing maintenance of competency. More sophisticated technology may become available and transportation and physical barriers to access may ease. But we believe this series demonstrates that procedural training and ongoing practice assessment can provide timely, safe, and appropriate access to the latest surgical techniques.
Since we closed this study, we have performed another 30 cases with similar excellent results and a substantial decrease in procedure and post-operative recovery time (90 minutes and 7 hours, respectively). Our ongoing assessment of our practice and performance improvement are integral to procedural excellence.
Conclusion
The authors have successfully delivered this well-defined surgical service in their community without any compromise in quality of care. The resources are unique, including training, team selection, and collaboration within a rural community hospital setting.
This experience suggests that an alternative model of practice and surgical training in family medicine may be feasible and offer effective, and perhaps superior results in rural communities. The inclusion of procedural skills in the scope of family medicine should be considered as a viable solution to the healthcare access and quality concerns of rural Americans.
· Acknowledgements ·
The authors thankfully acknowledge the advice and help received from: David Driggers, MD, Providence Family Practice Center, Anchorage, Alaska; Frank Kurzwez, MD, formerly Chairman, Department of Surgery, Louisiana State University Health Science Center, Shreveport; Debi P. Mukherjee, Sc.D, Associate Professor, Department of Orthopedic Surgery and Coordinator of Bio-Engineering, Louisiana State University Health Science Center, Shreveport; W. Norwood, MD, Chief, Department of Surgery, WK Hospital Health System, Shreveport; James Elrod, President, Willis-Knighton Hospital Health System, Shreveport; John Harlan Haynes III, MD, FABFP, MScMM (UT SWHSC), Med Alliance Health Center, Fort Worth, Tex; Jishnu Guha; and Indranil Guha.
