Mini-cholecystectomy, a standard of care and training standard in limited resource health facilities, an example from Sudan

Abstract

Abstract Background: Laparoscopic cholecystectomy is the gold standard treatment for gallstones disease. In limited resources hospitals in low and middle-income countries (LMIC) it had been under investigation; likewise, mini-cholecystectomy (MC) was not defined. This study arouses adaptation to reality. Objectives: To demonstrate the experience of surgical training in a limited resources health facility, to assess the trainer selection of cases for training and supervision in, and to compare the trainer vs. trainee duration in early outcomes. Methods: descriptive, prospective study done in Kassala state- Sudan, from January 2015 through December 2017. Data were collected prospectively from the patient records with direct observation of the outcome over the two-year period and fed to Statistical Package for Social Sciences (SPSS) Inc. Significant levels were taken for P ≥ 0.05 and 95% confidence interval values. Results: Total number of cases: 600 patients. Consultants are two; trainee registrars are eight, with a ratio of 1:4. Consultants have operated on 58% versus registrars 42%. The mean hospital stay for the patients was 2.9 days (±0.9 SD). The standard percentage of operations by the registrars has increased to 46% in the shortest hospital stay (2 days) and 61% at four days, but less than 42% in three- and five-days duration (P value = 0.0001). Conclusion: In large volume hospitals, training on mini-cholecystectomy was safe and acceptable standard of care in limited resources hospitals.