Hernández IRS, Rivero SJL, Quezada AI, Castillo GR, Flores RJF, Ávila RJL

Language: Spanish
References: 10
Page: 13-16
PDF size: 66.06 Kb.

ABSTRACT

Objective: To demonstrate that ambulatory laparoscopic cholecystectomy performed in second level health care hospitals is a safe procedure.
Setting: Second level health care hospital.
Design: Cohort, observational, prospective, descriptive, and longitudinal study.
Statistical analysis: Percentajes as summary measure for qualitative variables.
Patients and method: We studied patients with a diagnosis of chronic lithiasic cholecystitis or billiary dyskinesia from April 1999 to May 2006, in whom ambulatory laparoscopic cholecystectomies had been performed. Oral feeding was started at 4 h after surgery and patients were discharged at 8 h after surgery. The surgeon contacted the patient telephonically on the night of the surgery. Variables studied were: age, gender, type of programmed surgery, hospital re-admittance, complications, mortality, and working disability. We compared the costs of ambulatory and non-ambulatory laparoscopic cholecystectomies at the same time of the study.
Results: A total of 2,111 laparoscopic cholecystectomies were performed in the studied period, of which 907 (43.12%) corresponded to ambulatory surgeries, patients remained in the hospital for an average of 8 h, none required re-admittance nor medical care in the emergency ward. No mortalities were registered in the studied group. There were two patients with ecchymosis and superficial hematoma at the site of the umbilical incision. Working disability granted was of 8.2 days. A savings of $3,180.00 per patient was obtained in the outpatient group.
Conclusions: Outpatient laparoscopic cholecystectomy is a safe surgical procedure, which provides benefits in terms of decreased costs and reduction of hospital occupation, as well as a fast reintegration to the familial nucleus and to the working activities.

REFERENCES

1. Lam D, Miranda R, Hom SJ. Laparoscopic cholecystectomy as outpatient procedure. Am Coll Surg 1997; 185: 152-5.

2. Mjaland O, Raeder J, Aasboe V, Trondsen E, Buanes T. Outpatient laparoscopic cholecystectomy. Br J Surg 1997; 85: 958-61.

3. Pérez Castro E. Rev Med IMSS 2002: 71-5.

4. Justo JJM, Prado-Orozco E, Theurel VG, de la Rosa PR, Lozano EA. Cir Gen 2004; 26: 306-10.

5. Bueno-Lledó J, Planellis-Roig M, Sanahuja-Santafé A, García-Espinoza R, Arnau-Bertomeu C, Guillemot M. Factores intraoperatorios predictivos del fracaso del régimen ambulatorio tras colecistectomía laparoscópica. Cir Esp 2005; 78: 168-74.

6. Fallis WH, Scurrah D. Outpatient laparoscopy cholecystectomy: home visit versus telephone follow up. Can J Surg 2001; 44: 39-44.

7. Calland JF, Tanaka K, Foley E, Bovbjerg VE, Markey DW, Blome S, et al. Outpatient laparoscopic cholecystectomy: patients outcome after implementation of a clinical pathway. Ann Surg 2001; 233: 704-15.

8. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Recovery after uncomplicated laparoscopic cholecystectomy. Surgery 2002; 132: 817-25.

9. Jain PK, Hayden JD, Sedman PC, Royston CM, O´Boyle CJ. A prospective study of ambulatory laparoscopic cholecystectomy: training, economic, and patient benefits. Surg Endosc 2005; 19: 1082-5.

10. Robinson TN, Biffl WL, Moore EE, Heimback JK, Calkins CM, Burch JM. Predicting failure of outpatient laparoscopic cholecystectomy. Am J Surg 2002; 184: 515-9.