Laparoscopic cholecystectomy as a day-surgery procedure: Personal experience
Alessandro Anastasi, Domenico Frontera, Duccio Masini, Lorenzo Capezzuoli, Miriam Levi, Giuseppe CanonicoBackground:
Laparoscopic cholecystectomy in a day surgery setting (VLC/day surgery [DS]) has been recommended for several years, but this organizational model is slow to spread in surgical departments, often because of fear of complications in the first 24 postoperative hours. This retrospective study aimed to assess the feasibility and effectiveness of VLC/DS for uncomplicated symptomatic gallstones and to identify any factors that may influence delayed discharge.
Methods:
Perioperative variables of 102 subjects enrolled according to strict selective criteria were analyzed. Complications were defined and graded using the “Clavien–Dindo” classification system.
Results:
The mean operation time was 58.2 minutes. One laparotomy conversion was necessary because of bile duct injury. A subhepatic drainage was placed in four cases. There were no reported deaths. Postoperative morbidity was 12.7%. Active mobilization and oral intake resumed within scheduled times in 88 cases; pain was well controlled in 96% of cases. Eighty percent of patients were discharged within 7–10 hours of surgery. One patient required readmission for biliary leakage from the gallbladder bed. Only the duration of surgery was significantly related to late discharge, while the presence of drainage and complications were only confounding factors and therefore not causally valid in determining late discharge. Of the 71% of patients who responded to the satisfaction questionnaire, 93% judged the entire care pathway positively.
Conclusions:
The study demonstrates that the organizational model can be safely implemented in selected subjects and with a well-integrated and motivated surgical–anesthesiology team. Moreover, VLC/DS can combine patient satisfaction with cost-effectiveness.