Outpatient laparoscopic cholecystectomy: a new gold standard for cholecystectomy.

OBJECTIVE: To contribute our experience for five years in the implemetation of outpatient laparoscopic cholecystectomy (LC). PATIENTS: Between January 1999 and March 2004 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.

Colecistectomía laparoscópica ambulatoria. ¿El nuevo “gold standard” de la colecistectomía? / Outpatient laparoscopic cholecystectomy. A new gold standard for cholecystectomy?

Objetivo: aportar nuestra experiencia durante cinco años enla implantación de la colecistectomía laparoscópica (CL) en unprograma de cirugía mayor ambulatoria (CMA).Pacientes: entre enero de 1999 y marzo de 2004, se realizaron504 CL consecutivas en régimen ambulatorio. Se aplicaroncriterios de exclusión e inclusión, un procedimiento anestésico-quirurgicoprotocolizado, y criterios específicos al alta hospitalaria. Elmanejo postoperatorio se realizó en régimen de “fast track” o derecuperación rápida. Seguimiento postoperatorio estricto medianteprotocolo de revisiones, incluido localización telefónica el día dela colecistectomía.Resultados: el índice de sustitución de la serie global fue88,8%, siendo la estancia hospitalaria media de este grupo de 6,1horas. Cincuenta y un pacientes requirieron estancia nocturna enel hospital (10,1%), la mayoría por causas de índole “social”. Cincopacientes requirieron ingreso (entre 24 y 48 horas) por diferentescausas (conversión a cirugía abierta, neumotórax intraoperatorio,y complicaciones médicas postoperatorias). Seis pacientes(1,1%) fueron reingresados en nuestra clínica y se observó un11,6% de complicaciones postoperatorias en la serie global, dondeel dolor abdominal de tipo parietal fue la más frecuente. El contactoobligatorio telefónico a las 22,00 horas del mismo día de lacirugía se cumplió en el 100% de los casos ambulatorios. El seguimientopostoperatorio al mes de la intervención fue del 93,9% yal año, del 86,7% de los pacientes.Conclusiones: la CL en régimen ambulatorio se puede realizarde manera segura y fiable, y probablemente representa el nuevo“gold standard” del tratamiento de la colelitiasis sintomática

Objective: to contribute our experience for five years in theimplemetation of outpatient laparoscopic cholecystectomy (LC).Patients: between January 1999 and March 2004 we performed504 outpatient LCs. We applied both exclusion and inclusioncriteria, an anesthetic and surgical protocol, and discharge-specificcriteria. Postoperative management in “fast track” regime. Postoperativeperiod controlled by protocol, including phone calls aftercholecystectomy.Results: the ambulatory percentage in the global series was88.8%, and mean hospital stay was 6.1 hours. Fifty-one patientsrequired 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% postoperativecomplications in the global series, with abdominal parietal painbeing most frequent. Phone localization by 22.00 p.m. in thesame day of surgery was 100% complete for outpatient cases.Postoperative surveillance within the first month after surgery wascompleted in 93.9%, and within th first year in 86.7% of patients.Conclusions: outpatient LC is safe and feasible, and probablyrepresents a new “gold standard” in the treatment of symptomaticcholelithiasis