Feasibility of day case laparoscopic cholecystectomy in unselected patients

Abstract

The feasibility of day case laparoscopic cholecystectomy was assessed in unselected patients using a standard anaesthetic protocol. Postoperative pain and nausea were assessed at 6 and 24 h postoperatively (visual analogue scale, range 0-10). Thirty-two patients were studied (23 female, 9 male, mean age 49.6 years). The mean duration of surgery was 68 min. At 6 h after surgery, 10 patients (31%) had no pain at rest. For the group as a whole, the median pain score was 3 at rest (range 0-6), 4 on movement (0-9), and 5 on coughing (0-9) and eight patients (25%) were nauseated. At 24 h, 15 (46.9%) had no pain at rest. For the group as a whole, the median pain score was 1 at rest (0-7), 3 (0-6) on movement and 3 on coughing (0-9). The same eight patients were nauseated. Ten patients (31.3%) were judged fit for discharge at 6 h, and 28 (87.5%) by 24 h. There was no statistical difference in mean age or duration of surgery in those judged fit for early discharge compared to the study group as a whole. Nausea was an important factor in those unfit for discharge at 24 h. Selection criteria might improve these figures. From the results of our study, 24 h admission is a more realistic goal and will be suitable for most patients requiring laparoscopic cholecystectomy.

Elective laparoscopic cholecystectomy

“…In addition to allowing better planning of operating sessions, both in terms of service provision and training of junior doctors, it may allow a more efficient selection of patients for ambulatory LC [29]. Moreover, additional anesthetic measures may be taken to minimize postoperative emesis and dizziness [14,25], symptoms that pose limitations to the applicability of day case laparoscopy [14,27,32]. In patients undergoing laparoscopic surgery, these symptoms are more likely to develop after prolonged operations because they correlate with the duration of anesthesia [7,17] and the total amount of carbon dioxide used [15].…”

Is Laparoscopic Cholecystectomy Safe and Acceptable as a Day Case Procedure?

“…[6][7][8] All patients had abdomen ultrasound scan assessment and liver function tests (LFT) done preoperatively. In the event of deranged LFTs or dilated biliary tree on ultrasound scan, further investigations such as ERCP or magnetic resonance cholangiopancreatography were performed to ensure the clearance of the common bile duct (CBD) before embarking on LC procedure.…”

Ambulante und tageschirurgische Eingriffe

“…Insofern führen die unter Beteiligung eines Anästhesisten durchgeführ-ten kleineren Eingriffe am Auge (Kataraktchirurgie),Adenotomien und Tonsillektomien,Myringotomien,Exzision kleiner Läsionen der Haut oder des Unterhautgewebes, Sterilisationen und lokale Exzisionen von Läsionen der weiblichen Brust sowie endoskopische Cholezystektomien die "Hitliste" des etwa 24.000 Prozeduren umfassenden Katalogs der vom National Center for Health Statistics für die Jahre 1994-1996 veröffentlichten Zusammenstellung an [28]. Fortschritte der chirurgischen Technik, insbesondere die Verbreitung endoskopischer Techniken, bringen als "minimal-invasive Chirurgie" eine deutliche Reduktion des chirurgischen Zugangstraumas mit sich und erlauben, wie sich am Beispiel der laparoskopischen Cholezystektomie zeigt, die ambulante Durchführung von Eingriffen, die vor wenigen Jahren noch dem stationären Bereich vorbehalten waren [52,86,96].…”