Outpatient laparoscopic cholecystectomy: A new gold standard for cholecystectomy?

Abstract

we performed 504 outpatient LCs. We applied both exclusion and inclusion criteria, an anesthetic and surgical protocol, and discharge-specific criteria. Postoperative management in "fast track" regime. Postoperative period controlled by protocol, including phone calls after cholecystectomy.Results: the ambulatory percentage in the global series was 88.8%, and mean hospital stay was 6.1 hours. Fifty-one patients required overnight stays (10.1%), most of them for "social" causes. Five patients required admission (between 24 and 48 hours) for different causes (conversion to laparotomy, intraoperative neumothorax, and postoperative medical complications). Six patients (1.1%) were readmitted, and we observed 11.6% postoperative complications in the global series, with abdominal parietal pain being most frequent. Phone localization by 22.00 p.m. in the same day of surgery was 100% complete for outpatient cases. Postoperative surveillance within the first month after surgery was completed in 93.9%, and within th first year in 86.7% of patients.Conclusions: outpatient LC is safe and feasible, and probably represents a new "gold standard" in the treatment of symptomatic cholelithiasis.

SAGES guidelines for the clinical application of laparoscopic biliary tract surgery

“…Control of postoperative pain, nausea, and vomiting is important to successful same-day discharge [168], and admission rates despite planned same-day discharge are reported to be 1-39%; patients older than 50 years may be at increased risk for admission [168][169][170][171][172][173][174]. Readmission rates range from 0 to 8%; common causes for readmission after sameday discharge include pain, intra-abdominal fluid collections, bile leaks, and bile duct stones [167,170].…”

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

“…Several variants of LC have been described, but evidence about their effectiveness is scarce (Low quality evidence). On the other hand, there is no evidence of major complications with outpatient LC (Low quality evidence) (Al-Ghnaniem, 2003;Koc, 2003;Harling, 2000;SIGN, 2004;Ladocsi, 1997;Millat, 1997;Thornton, 2002;Kitano, 1993;Barczynski, 2004;Nande, 2002;Trichak, 2003;Novitsky, 2005;Lai, 2003;Zhou, 2006;Corbitt, 1991;Bordelon, 1993;Lane GE, 1993;Janssen, 2003;Cengiz, 2005;Edelman, 1995;Shekarriz, 2003;Bencini, 2003;Yano, 2003;Verma, 2006;Grace, 1991;Martinez Vieira, 2004;Lau, 2002;Pattillo, 2004;Bueno Lledo, 2006).…”

“…In the 90s, LC was regarded as a way to reduce hospital stay in patients undergoing cholecystectomy (Verma, 2006). However, this potential benefit of LC with early discharge versus the standard protocol is supported only by observational studies with non-conclusive results (Grace, 1991;Martinez Vieira, 2004;Lau, 2002;Pattillo, 2004;Bueno Lledo, 2006), (Treatment studies 4).…”

Factores asociados a ingreso no previsto tras colecistectomía laparoscópica en régimen de cirugía mayor ambulatoria

“…La tasa de reingresos es un indicador clave ya que nos muestra aquellos casos que en el momento del alta se encontraban bien y no se sospechaba que el pró ximo desarrollo de una complicació n obligaría a ingresar al paciente de nuevo. En nuestra serie hubo 10 reingresos (2,8%) (tabla 1), tasa similar a la publicaba por otros autores [13][14][15][16][17][18][19][20][21][22][23][24][25][26] (tabla 4). La tasa de reintervenciones es otro dato muy importante.…”

“…No hubo mortalidad entre nuestros pacientes. Actualmente despué s de má s de 2 decenios de experiencia en CL como CMA y de numerosas publicaciones [13][14][15][16][17][18][19][20][21][22][23][24][25][26] (tabla 4) y (tabla 5) 7-11,24,27-31 y metaaná lisis 32,33 parece que la seguridad de esta té cnica está claramente demostrada. Sin embargo la tasa de ingresos inesperados, no deseados o, como los denominamos nosotros, «fallos de CMA» es elevada.…”