Feasibility of Routine Ambulatory Laparoscopic Cholecystectomy in Brazil

Abstract

Background and Objectives: In several developed countries, most laparoscopic cholecystectomies (LCs) are performed as an ambulatory operation (ALC) with a high rate of success. In Latin America, the experience with this procedure is still limited. Our objective is to evaluate the feasibility to implement ALC in a Brazilian teaching hospital. Methods: Data obtained from electronic medical records and study protocols of all patients who underwent an LC between January 2011 and March 2018 were evaluated. All patients with chronic or acute cholecystitis were initially considered for an ALC. Results: Of a total of 1645 patients who underwent LC, 1577 (95.9%) were discharged on the same day of the operation. The main reasons for hospital admission after ALC were patient refusal to be discharged (n = 23; 1.4%), nausea and vomiting (n = 15; 0.9%), and complicated acute cholecystitis. No patient was excluded from consideration for ALC based only on age, history of previous upper abdominal operation, and presence of comorbidity. Patient age ranged from 12 to 100 years, with a mean of 50.23 ± 15.35 years. Intraoperative and postoperative complication rates were 0.4% and 5.5%, respectively. Most perioperative complications were because of technical surgical difficulties and complications common to most abdominal operations (surgical site, pulmonary, urinary, and venous complications). Thirteen (0.8%) patients were readmitted to the hospital because of abdominal pain and fever (n = 4), pneumonia (n = 3), deep venous thrombosis (n = 3), or urinary retention (n = 3). Conclusions: ALC may be performed in Brazil with low rates of morbidity, mortality, and hospital readmission. Its implementation should be stimulated in Latin America.

Liver transplantation for the treatment of iatrogenic bile duct injury

“…Similar to other studies, the main cause of BDI in our series was cholecystectomy. Although the risk of BDI is low in a patient undergoing cholecystectomy, in general this operation is the main cause of BDI, as cholecystectomy is the most commonly performed abdominal operation worldwide 5 . Most studies, including ours, show that the rate of BDI is higher in females, as cholecystectomy is performed three to four times more commonly in this gender due to the higher prevalence of gallstones in females 5 , 13 .…”

“…Although cholecystectomy is by far the leading cause of iatrogenic bile duct injury, other important causes are reported, including upper abdominal operations and percutaneous or endoscopic procedures. Cholecystectomy is the most common intra-abdominal surgical procedure worldwide, with an estimated incidence of bile duct injury (BDI) between 0.3-0.6% [4][5][6][7] . When the injury progresses to biliary stricture, it results in chronic exposure of the canalicular membrane to hepatotoxic bile acids.…”

Thirty-Day Unplanned Readmission After Ambulatory Laparoscopic Cholecystectomy in Western China: A Retrospective Study

“…It is found that the most unplanned readmission happened during the first seven days after discharge. Like opening cholecystectomy, ambulatory LC carries some postoperative complications as well, including wound pain, wound infection, vomiting, nausea, and urinary retention, at the early stage after surgery [ 21 ]. Rosero and Joshi [ 14 ] reported that 64.4% patients receiving ambulatory LC had unplanned readmission records in the first seven days after discharge, and 11.1% were readmitted in the first 24 hours after discharge.…”

Transplante hepático no tratamento da lesão iatrogênica da via biliar

“…Semelhante a outros estudos, a principal causa de LDB em nossa série foi a colecistectomia. Embora o risco de LDB seja baixo em um paciente submetido à colecistectomia, em geral essa operação é a principal causa de LDB, pois a colecistectomia é a operação abdominal mais realizada em todo o mundo 5 . A maioria dos estudos, incluindo o nosso, mostra que a taxa de LDB é maior no gênero feminino, pois a colecistectomia é realizada 3 a 4 vezes mais comumente nesse gênero devido à maior prevalência de cálculos biliares no gênero feminino 5,13 .…”

“…Embora a colecistectomia seja de longe a principal causa de lesão iatrogênica do ducto biliar, outras causas importantes são relatadas, incluindo operações abdominais superiores e procedimentos percutâneos ou endoscópicos. A colecistectomia é o procedimento cirúrgico intra-abdominal mais comum em todo o mundo, com incidência estimada de lesão do ducto biliar (LDB) entre 0,3-0,6% [4][5][6][7] . Quando a lesão evolui com estenose biliar, resulta em exposição crônica da membrana canalicular aos ácidos biliares hepatóxicos.…”