Laparoscopic cholecystectomy as an ambulatory surgical procedure

Is it feasible in our context?

Abstract

Introduction: laparoscopic cholecystectomy is the most frequent major surgery in Uruguay. Given its low morbimortality rates and fast recovery it has been included in an ambulatory surgical procedures program.
Objective: to assess feasibility of including laparoscopic cholecystectomy in an ambulatory surgical procedures program in public hospitals in Uruguay.
Method: multi-center (University Hospital, Español Hospital and the Armed Forces Central Hospital), cooperative, descriptive and retrospective study of patients who underwent laparoscopic cholecystectomy (CIE-9-mc 51.23) as an ambulatory surgery between June, 2012 and June, 2015. Ambulatory surgery was defined as that which implied hospital stays equal to or lower than 12 hours. Inclusion criteria: ASA I, II, living in an urban area with the appropriate support network, telephone and private means of transport available. Exclusion criteria: patients with choledocholithiasis, history of negative surgical events due to anesthesia. Demographic data were collected, as well as surgery incidents and complications and postoperative surgery upon 30 days.
Results: 32 patients were recruited (age ranged between 17 and 66 years old), 26 of them were female. Laparoscopic cholecystectomy was performed in 30 patients, and patients were discharged between 6 to 12 hours after the postoperative. Two patients who accepted to participate in the program referred postoperative parietal pain which prevented them from an early discharge and were excluded. One patient was diagnosed with choledocholithiasis in the intraoperative cholangiography and a transcystic  choledocholithotomy was performed with no complications, acting within the protocol. No patients were excluded as a result of intraoperative incidents or accidents. No postoperative morbility was recorded in the programed follow up at the policlinic one week after surgery and 30 days after the postoperative. No patient felt symptoms that caused consultation at the emergency room during the above mentioned period of time.
Conclusions: the results of this experience seem to prove that laparoscopic cholecystectomy in ambulatory surgery is applicable to our public services in an effective and safe way. We point out the importance of a rigorous selection of patients and emphasize on the fact that is advisable for patients to voluntary enter the program, and they need for understand well the procedure and its risks. Also, facilities must be available for home support and access to health care centers, and discharge on the day the surgery is performed will depend on the absence of events that indicate the need for a longer postoperative observation.