Outpatient Laparoscopic Cholecystectomy at Ambulatory Surgical Center

Kwon, O H; Kim, S K; Mun, D B; Yun, Y K

Abstract

BACKGROUND: Laparoscopic cholecystectomy has become accepted worldwide as the procedure of choice for managing elective gallbladder pathology. In recent years, however, It is still done mainly on an inpatient basis at hospitals. With the remarkable success of laparoscopic cholecystectomy, reduced pain, rapid recovery & reduced postoperative hospital stay of less than two days on average, minimal tissue trauma, and low complication rate, outpatient laparoscopic cholecystectomy seems feasible for many patients. We undertook the following study retrospectively to evaluate the safety and utility of outpatient laparoscopic cholecystectomy
METHODS
We reviewed 119 cases in which outpatient laparoscopic cholecystectomy were done at an ambulatory surgical center of the Kyungpook University Hospital between Apr. 1998 and Jun. 2000. Patients were selected on the basis of medical history, physical examination, and all patients were diagnosed by abdominal ultrasonographic examination. Selection criteria for outpatient laparoscopic cholecystectomy included history of symptomatic cholelithiasis without any acute sign, symptoms, or jaundice when scheduled for elective outpatient surgery. Patients were excluded from outpatient consideration if they had significant comorbid disease, or previous upper abdominal surgery. Patients were required to spend the first evening in the city if possible for easy accessibility to hospital should complication rises.
RESULTS
1. Of 119 patients, 73(61.3%) were discharged on the same day and so they were considered outpatients. There was no serious postoperative complication other than moderate pain which requires only the pain control. 2. Of 119 patients, 42 were admitted after laparoscopic cholecystectomy. The primary reason for patient's admission was patient's preference without any special reason or due to mild pain. 3. 4 of 119 patients required conversion to open cholecystecomy. Reasons for this conversion were severe adhesion in two cases due to chronic cholecystitis, bile duct injury due to anomalous cystic duct in one case, and GB empyema in one case. 4. Using visualized analog scale, It showed relatively high degree of satisfaction of outpatients compare to admitted patients.
CONCLUSION
Elective ambulatory laparoscopic cholecystectomy can be as effective and practical as an inpatient procedure if patients are selected appropriately. The outpatients approach can be considered an ethical choice for the patients who need laparoscopic cholecystectomy.