Laparoscopic cholecystectomy as an ambulatory surgical procedure
Is it feasible in our context?
Abstract
Introduction: laparoscopic cholecystectomy is the most frequent major surgery in Uruguay. Given its low morbimortality rates and fast recovery it has been included in an ambulatory surgical procedures program.
Objective: to assess feasibility of including laparoscopic cholecystectomy in an ambulatory surgical procedures program in public hospitals in Uruguay.
Method: multi-center (University Hospital, Español Hospital and the Armed Forces Central Hospital), cooperative, descriptive and retrospective study of patients who underwent laparoscopic cholecystectomy (CIE-9-mc 51.23) as an ambulatory surgery between June, 2012 and June, 2015. Ambulatory surgery was defined as that which implied hospital stays equal to or lower than 12 hours. Inclusion criteria: ASA I, II, living in an urban area with the appropriate support network, telephone and private means of transport available. Exclusion criteria: patients with choledocholithiasis, history of negative surgical events due to anesthesia. Demographic data were collected, as well as surgery incidents and complications and postoperative surgery upon 30 days.
Results: 32 patients were recruited (age ranged between 17 and 66 years old), 26 of them were female. Laparoscopic cholecystectomy was performed in 30 patients, and patients were discharged between 6 to 12 hours after the postoperative. Two patients who accepted to participate in the program referred postoperative parietal pain which prevented them from an early discharge and were excluded. One patient was diagnosed with choledocholithiasis in the intraoperative cholangiography and a transcystic choledocholithotomy was performed with no complications, acting within the protocol. No patients were excluded as a result of intraoperative incidents or accidents. No postoperative morbility was recorded in the programed follow up at the policlinic one week after surgery and 30 days after the postoperative. No patient felt symptoms that caused consultation at the emergency room during the above mentioned period of time.
Conclusions: the results of this experience seem to prove that laparoscopic cholecystectomy in ambulatory surgery is applicable to our public services in an effective and safe way. We point out the importance of a rigorous selection of patients and emphasize on the fact that is advisable for patients to voluntary enter the program, and they need for understand well the procedure and its risks. Also, facilities must be available for home support and access to health care centers, and discharge on the day the surgery is performed will depend on the absence of events that indicate the need for a longer postoperative observation.
References
(1) Tiryaki C, Bayhan Z, Kargi E, Alponat A. Ambulatory laparoscopic cholecystectomy: A single center experience. J Minim Access Surg 2016; 12(1):47-53.
(2) Goulart A, Delgado M, Antunes MC, Braga Dos Anjos J. 231 colecistectomias laparoscópicas em ambulatorio: que resultados? Acta Med Port 2013; 26(5):564-8.
(3) Ahn Y, Woods J, Connor S. A systematic review of interventions to facilitate ambulatory laparoscopic cholecystectomy. HPB (Oxford) 2011; 13(10):677-86.
(4) Akoh JA, Watson WA, Bourne TP. Day case laparoscopic cholecystectomy: reducing the admission rate. Int J Surg 2011; 9(1):63-7.
(5) Davis JE. The major ambulatory surgical center and how it is developed. Surg Clin North Am 1987; 67(4):671-92.
(6) Ferraina PA. Cirugía ambulatoria: relato en LXII Congreso Argentino de Cirugía. Rev Argent Cir 1991; 61(nº extr):2-61.
(7) Jaramillo Mejia J. Principios filosóficos de la cirugía ambulatoria. Rev Colomb Anestesiol 2005; 33(4):215-7. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-33472005000400001. Consulta: 10 julio 2016.
(8) Sato A, Terashita Y, Mori Y, Okubo T. Ambulatory laparoscopic cholecystectomy: An audit of day case vs overnight surgery at a community hospital in Japan. World J Gastrointest Surg 2012; 4(12):296-300.
(9) Ji W, Ding K, Li LT, Wang D, Li N, Li JS. Outpatient versus inpatient laparoscopic cholecystectomy: a single center clinical analysis. Hepatobiliary Pancreat Dis Int 2010; 9(1):60-4.
(10) Briggs CD, Irving GB, Mann CD, Cresswell A, Englert L, Peterson M, et al. Introduction of a day-case laparoscopic cholecystectomy service in the UK: a critical analysis of factors influencing same-day discharge and contact with primary care providers. Ann R Coll Surg Engl 2009; 91(7):583-90.
(11) Teixeira UF, Goldoni MB, Machry MC, Ceccon PN, Fontes PR, Waechter FL. Ambulatory laparoscopic cholecystectomy is safe and costeffective: a Brazilian single center experience. Arq Gastroenterol 2016; 53(2):103-7.
(12) Bona S, Monzani R, Fumagalli Romario U, Zago M, Mariani D, et al. Outpatient laparoscopic cholecystectomy: a prospective study of 250 patients. Gastroenterol Clin Biol 2007; 31(11):1010-5.
(13) Matteucci P. Cirugía ambulatoria. Cir Urug 1991; 61(5/6):168-70.
(14) Estapé Carriquiry G. Cirugía ambulatoria. Cir Urug 2002; 72(1): 8-12.
(15) Chirigliano GV, Noceti MC. Planificación de una unidad de cirugía del día. Rev Méd Urug 2004; 20(1):19-31.
(16) Chirigliano GV, Noceti MC. Evaluación de una unidad de cirugía del día. Rev Panam Salud Pública 2002; 12(5):333-8.
(17) Nari G, Oliva F, Prenna J, Moreno E, Olivares S. Tratamiento de la hernia inguinal con cirugía ambulatoria. Cir Urug 1997; 67(1):20-3.
(18) Reddick EJ, Olsen DO. Outpatient laparoscopic laser cholecystectomy. Am J Surg 1990; 160(5):485-7.
(19) Marín J. Horizonte sostenible para la cirugía mayor ambulatoria. Cir May Amb 2012; 17(1):4-5. Disponible en: http://www.asecma.org/horizonte-sostenible-para-la-cirugia-mayor-ambulatoria_108.aspx. Consulta: 10 julio 2016.
(20) Martínez Ramos C. Cirugía mayor ambulatoria: implantación en España. Perspectivas de futuro. Reduca 2009; 1(1):305-16. Disponible en: http://www.revistareduca.es/index.php/reduca/article/viewFile/62/92. Consulta: 10 julio 2016.
(21) Menéndez Gac C. Cirugía mayor ambulatoria: Clínica Quilín, Hospital Clínico de la Universidad de Chile. En: 18° Congreso Latinoamericano de Arquitectura e Ingeniería Hospitalaria. Buenos Aires, 2007.
(22) Rojas Pérez E. Evolución de la cirugía ambulatoria. Rev Mex Anest 2012; 35(Supl 1):S108-11. Disponible en: http://www.medigraphic.com/pdfs/rma/cma-2012/cmas121c6.pdf. Consulta: 10 julio 2016.
(23) Planells Roig M, Arnal Bertomeu C, Garcia Espinosa R, Cervera Delgado M, Carrau Giner M.Colecistectomía laparóscopica ambulatoria por minilaparoscopia versus colecistectomía laparóscopica ambulatoria multipuerto tradicional: estudio prospectivo aleatorizado. Cir Esp 2016; 94(2):86-92.
(24) Martínez Vieira A, Docobo Durántez F, Mena Robles J, Durán Ferreras I, Vázquez Monchul J, López Bernal F, et al. Colecistectomía laparoscópica en el tratamiento de la litiasis biliar: ¿cirugía mayor ambulatoria o corta estancia? Rev Esp Enferm Dig 2004; 96(7):452-9.
(25) Morales García D, Martín Oviedo J, García Somacarrera E, Naranjo Gómez A. ¿Por qué es tan difícil generalizar la colecistectomía laparoscópica en régimen de cirugía mayor ambulatoria? Cir Esp 2009; 86(2):122-4.
(26) Planells Roig M, García Espinosa R, Cervera Delgado M, Navarro Vicente F, Carrau Giner M, Sanahuja Santafé A, Arnal Bertomeu C. Colecistectomía laparoscópica ambulatoria: estudio de cohortes de 1.600 casos consecutivos. Cir esp 2013; 91(3):156-62.
(27) Lezana Pérez MA, Carreño Villarreal G, Lora Cumplido P, Álvarez Obregón R. Colecistectomía laparoscópica ambulatoria versus con ingreso: estudio de efectividad y calidad. Cir Esp 2013; 91(7):424-31.
(28) Jiménez Fuertes M, Costa Navarro D. Colecistectomía laparoscópica ambulatoria y control del dolor postoperatorio: presentación de una serie de 100 casos. Cir Esp 2015; 93(3):181-6.
(29) Bueno Lledó J, Granero Castro P, Gómez i Gavara I, Ibañez Cirión JL, López Andújar R, García Granero E. Veinticinco años de colecistectomía laparoscópica en régimen ambulatorio. Cir Esp 2016; 94(8):429-41.
(30) Soler Dorda G, San Emeterio González E, Martón Bedia P. Factores asociados a ingreso no previsto tras colecistectomía laparoscópica en régimen de cirugía mayor ambulatoria. Cir Esp 2016; 94(2):93-9.
(31) Ali A, Altun D, Oguz BH, Ilhan M, Demircan F, Koltka K. The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy. J Anesth 2014; 28(2):222-7.
(32) Hessami MA, Yari M. Granisetron versus dexamethasone in prophylaxis of nausea and vomiting after laparoscopic cholecystectomy. Anesth Pain Med 2012; 2(2):81-4.
(33) Nicolau AE, Merlan V, Grecu I, Nicolau M, Micu B. Multimodal analgesia in elective laparoscopic cholecystectomy. A double-blind randomized controlled trial. Chirurgia (Bucur) 2008; 103(5):547-51.
(34) Tang H, Dong A, Yan L. Day surgery versus overnight stay laparoscopic cholecystectomy: A systematic review and meta-analysis. Dig Liver Dis 2015; 47(7):556-61.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
