RESUMO
BACKGROUND: The objective of this study was to evaluate the impact of more convincing and reassuring remarks from the surgeon in the preoperative consult associated with a dedicated outpatient facility to increase our rate of success in outpatient laparoscopic cholecystectomy. METHODS: A one-centre prospective clinical study was conducted between February 2013 and May 2015. During the first time period (February 2013-March 2014), patients were hospitalized in conventional care unit and given the possibility to choose an outpatient procedure. In the second phase (April 2014-May 2015), the patients were held in a dedicated outpatient facility. Outpatient success rate was evaluated using Chung's discharge score 6 h after surgery. RESULTS: Eighty patients were included (30 in a traditional setting, 50 in an optimal clinical pathway). Both groups were comparable for mean age, American Society of Anesthesiologists score and mean operative time (P = 0.36, P = 1 and P = 0.09, respectively). Success in outpatient surgery was significantly higher in the optimal clinical pathway group (73.3% versus 96%, P = 0.005). The only criteria which was significantly improved in Chung score was perambulation (P = 0.001). There was no significant difference between the two groups for post-operative complications (P = 0.28) or readmission (P = 1). CONCLUSION: Optimal clinical pathway (more convincing and reassuring remarks in the preoperative consult and a dedicated outpatient facility) is the key to increase success in outpatient laparoscopic cholecystectomy.
RESUMO
BACKGROUND: The objective of this study was to evaluate the interest of using ropivacaine for outpatient laparoscopic cholecystectomy. The use of local anesthesia by instillation and infiltration could reduce pain and increase the number of outpatient cholecystectomies. METHODS: A one-center randomized prospective clinical trial compared the use of ropivacaine during outpatient laparoscopic cholecystectomy to the control group of outpatients for laparoscopic cholecystectomy between April 2014 and May 2015. One hundred twenty-four were eligible, and 100 patients were randomized. Patients with outpatient cholecystectomy were randomized into 2 groups: ropivacaine group (Rop group) and control group (control group). We performed a ropivacaine intraperitoneal instillation and wound infiltration for the ropivacaine group at the end of the procedure. The primary observation was authorization for home discharge. The patient was evaluated by the surgeon using the Chung score. Secondary observations included postoperative pain at 2 h post-surgery, at 6 h post-surgery and the day following surgery. RESULTS: Ninety-eight were able to leave on the evening of surgery. At 6 h post-surgery, the Chung score was identical for both groups (p = 0.73). At 2 and 6 h post-surgery and the day following surgery, there was no significant difference in pain levels (p = 0.63; p = 0.61; p = 0.98). Analgesic consumption was no significant difference in the groups. CONCLUSIONS: The use of ropivacaine does not increase the rate of home discharge and does not change the postoperative pain of outpatient cholecystectomy.