Feasibility and cost effectiveness of ambulatory laparoscopic cholecystectomy. A retrospective cohort study

Manzia, Tommaso Maria; Quaranta, Claudia; Filingeri, V.; Toti, Luca; Anselmo, Alessandro; Tariciotti, Laura; Carolis, Gerardo De; Cacciola, Roberto; Lorenzo, Nicola Di; Sorge, Roberto; Angelico, Roberta; Monteleone, Giovanni; Tisone, Giuseppe

doi:10.1016/j.amsu.2020.04.036

Cited by 24 publications

(16 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The current survey shows that only 39% of Centers routinely perform cholecystectomy in a day case ambulatory setting. It is well-known that an ambulatory regimen is both feasible and cost-effective [ 18 , 19 ], therefore this strategy could be a good option in the current pandemic to limit any further hospital overload. However, the high turnover of patients and healthcare providers in ambulatory care services, despite reducing hospitalization, could be a further potential source of viral infection among the medical staff in the course of their daily activity.…”

Section: Discussionmentioning

confidence: 99%

Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Manzia¹,

Angelico²,

Parente³

et al. 2020

Annals of Medicine and Surgery

Self Cite

View full text Add to dashboard Cite

Background Since the Coronavirus disease-19(COVID-19) pandemic, the healthcare systems are reallocating their medical resources, with consequent narrowed access to elective surgery for benign conditions such as gallstone disease(GD). This survey represents an overview of the current policies regarding the surgical management of patients with GD during the COVID-19 pandemic. Methods A Web-based survey was conducted among 36 Hepato-Prancreato-Biliary surgeons from 14 Countries. Through a 17-item questionnaire, participants were asked about the local management of patients with GD since the start of the COVID-19 pandemic. Results The majority (n = 26,72.2%) of surgeons reported an alarming decrease in the cholecystectomy rate for GD since the start of the pandemic, regardless of the Country: 19(52.7%) didn't operate any GD, 7(19.4%) reduced their surgical activity by 50–75%, 10(27.8%) by 25–50%, 1(2.8%) maintained regular activity. Currently, only patients with GD complications are operated. Thirty-two (88.9%) participants expect these changes to last for at least 3 months. In 15(41.6%) Centers, patients are currently being screened for SARS-CoV-2 infection before cholecystectomy [in 10(27.8%) Centers only in the presence of suspected infection, in 5(13.9%) routinely]. The majority of surgeons (n = 29,80.6%) have adopted a laparoscopic approach as standard surgery, 5(13.9%) perform open cholecystectomy in patients with known/suspected SARS-CoV-2 infection, and 2(5.6%) in all patients. Conclusion In the ongoing COVID-19 emergency, the surgical treatment of GD is postponed, resulting in a huge number of untreated patients who could develop severe morbidity. Updated guidelines and dedicated pathways for patients with benign disease awaiting elective surgery are mandatory to prevent further aggravation of the overloaded healthcare systems.

show abstract

Section: Discussionmentioning

confidence: 99%

Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Manzia¹,

Angelico²,

Parente³

et al. 2020

Annals of Medicine and Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…In other studies, they patients with gall stones and acute cholecystitis attack the management was guided on basis of symptoms severity. ASA class, CCI index (Tokyo Guidelines severity risk scale grading) planned for laparoscopic cholecystectomy need to be done at a tertiary care setup with support of functional intensive care after full peri-operative optimization and these patients cannot be discharged on same day of procedure 20,21,22 . Early surgical laparoscopic cholecystectomy for acute cholecystitis cases even with medical diseases is the approach recommended in another study 23,24 .…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia Concern in High-Risk Cases Under-Going Ambulatory Laparoscopic Cholecystectomy

Maqbool¹,

Alam²,

Draz³

et al. 2021

J. Bahria Univ. Med. Dent. Coll.

View full text Add to dashboard Cite

Objective:To evaluate pre-operative implications, anesthetic management and post-operative anesthetic concerns in patientswith co-morbid diseases undergoing ambulatory laparoscopic cholecystectomy under general anesthesia. Study Design and setting:Retrospective study was conducted at Rawal Institute of Health Sciences, Islamabad from 8thOct 2017 to 5th Nov 2018. Methodology:Total one hundred and twelve patients were placed in American society of Anaesthesiologist (ASA) classII, III & IV (medically optimized) on pre-operative evaluation for ambulatory laparoscopic cholecystectomy. Generalanesthesia was administered with co-induction (nalbuphine 0.1mg/kg plus midazolam 0.01mg/kg) tracheal intubationfacilitated by 0.15mg/kg cis-atracurium. Post-operatively on clinical status evaluation and Post Anesthesia Discharge score,patients were shifted to respective ward /intensive care. Statistical analysis was done by SPSS v.21. Results:Pre-operatively medical and cardiologist evaluation was taken in 34(30.35%) and 42(37.5%) cases respectivelywhereas consultant anesthesiologist reviewed all cases. In study single case was converted to open method due to mirrizisyndrome and adhesions creating difficult laparoscopic dissection in 9(8.03%) of cases. Post-operatively in single caseatrial fibrillation with fast ventricular response noted followed by sudden bradycardia, managed and sinus rhythm restored,whereas in other case of ischemic heart disease with viral respiratory infection, needed ventilatory support after 2 hoursdue to respiratory distress and weaned off after 24hrs. In the study 76(67.9%) cases were shifted post-operatively to surgical ward and 36 cases (32.1%) needed intensive care treatment. Conclusion:Laparoscopic cholecystectomy in patients with co-morbid states requires balanced anesthetic technique considering consequences of pneumoperitoneum to decrease morbidity.

show abstract

“…The diagnosis of biliary lithiasis is usually straightforward due to widely available ultrasound (US) imaging equipment, allowing for the systematic examination of patients presenting with a clinical picture of acute or chronic abdominal pain. However, due to continuous efforts to reduce the costs and the length of hospital stay for patients with gallstones, a more advanced routine preoperative evaluation is avoided (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Synchronous biliary gallstones and colorectal cancer: A single center analysis

Zarnescu

Dumitrascu

et al. 2021

Exp Ther Med

View full text Add to dashboard Cite

Gallstones and colorectal cancer (CRC) are two common disorders that may develop simultaneously. In such situations, there is a significant chance of missing one of the conditions due to the primary clinical presentation. Late detection, diagnosis and treatment can be especially problematic in the case of unrecognized CRC. In the present study, the medical charts were retrospectively reviewed for all consecutive patients who were treated in the Second Department of Surgery, University Emergency Hospital Bucharest (Romania) between February 2015 and December 2017 following a diagnosis of CRC and/or biliary stones. There were 203 patients with CRC, 433 with biliary gallstones and 19 patients with both conditions. There were 125 men (61.6%) in the CRC group and 138 men (31.9%) in the gallstone group. The average age was 54.1±15.9 years in the gallstone group and 66.1±11.6 years in the CRC group. Obesity was observed in 96 patients (22.2%) with gallstones and in 14 (6.9%) patients in the CRC group. In the CRC group, 80 patients had medical comorbidities (39.4%), while in the gallstone group 126 patients (29.1%) had medical comorbidities. Bivariate analysis comparing gallstone only vs. gallstone and CRC identified age (P=0.001), male sex (P=0.001) and thyroid disease (P=0.001) as significant factors associated with synchronous diagnosis. The multivariable logistic regression of factors predicting CRC in patients with gallstones identified age (OR, 1.06; 95% CI, 1.023-1.105; P=0.002) and thyroid diseases (OR, 11.15; 95% CI, 2.532-49.06; P=0.001) as independent factors. There were significant differences regarding the location of the tumor between the CRC-only group and the gallstone and CRC group (P=0.001): Rectum (39.7 vs. 5.3%), left colon (26.6 vs. 21.1%), transverse colon (13 vs. 26.3%) and right colon (20.7 vs. 47.4%). The study concluded that, in patients with gallstones, age and thyroid conditions were significantly associated with CRC. Patients with a synchronous diagnosis of gallstones and CRC had significantly more right-sided CRC compared with regular CRC.

show abstract

Feasibility and cost effectiveness of ambulatory laparoscopic cholecystectomy. A retrospective cohort study

Cited by 24 publications

References 19 publications

Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Anaesthesia Concern in High-Risk Cases Under-Going Ambulatory Laparoscopic Cholecystectomy

Synchronous biliary gallstones and colorectal cancer: A single center analysis

Contact Info

Product

Resources

About