Interest of Using Ropivacaine for Outpatient Laparoscopic Cholecystectomy: Prospective Randomized Trial.

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.

Outcome after surgical treatment of gastrointestinal stromal tumors.

OBJECTIVES: The objectives were to determine among gastrointestinal mesenchymal tumors treated surgically in our unit which were gastrointestinal stromal tumors (GISTs) and to describe their characteristic features and prognostic factors. METHODS: A second histological and immunohistochemical reading was performed for 56 gastrointestinal mesenchymal tumors, treated surgically in the Reims University Hospital between 1990 and 2005 in order to determine which ones were GISTs. A statistical descriptive and analytical analysis of the demographic, pathological, therapeutic and prognostic factors was performed. RESULTS: Eighty-seven percent of the tumors were GISTs. The 5-year specific survival rate was 66.8%. The factors of good prognosis were small tumor size, low mitotic count, complete primary tumor resection without tumor effraction, age less than 60 years, absence of mucosal necrosis, ulceration, and invasion. Type of surgical resection had no impact in terms of survival. CONCLUSION: GISTs are the most common mesenchymal tumors of the digestive tract. Even thought treatment with imatinib is currently available, surgery (preferably total resection without effraction) is the mainstay treatment for GISTs.