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J Surg Res. 2014 Jan;186(1):142-9. doi: 10.1016/j.jss.2013.09.011. Epub 2013 Oct 2.

Can we consider day-case laparoscopic cholecystectomy for acute calculous cholecystitis? Identification of potentially eligible patients.

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  • 1Department of Digestive and Metabolic Surgery, Amiens University Medical Center, Amiens, France; Inserm U1088 Faculty of Medicine, University of Picardie Jules Verne, Amiens, France.

Abstract

BACKGROUND:

Day-case laparoscopic cholecystectomy has not yet been validated for acute cholecystitis. We sought to identify a subgroup of acute cholecystitis patients having been hospitalized overnight after laparoscopic cholecystectomy but who could have been eligible for day-case surgery.

METHODS:

We identified patients treated for acute cholecystitis with laparoscopic cholecystectomy in our university medical center between May 1, 2010, and May 31, 2012, and who lacked contraindications for day-case surgery. In a second step, we assumed that patients hospitalized for <3 d would have been eligible for day-case surgery. We then compared patients hospitalized for ≤3 d with those hospitalized for >3 d in terms of demographic data, laboratory test results, and surgical procedures.

RESULTS:

The study population comprised 86 men and 82 women (median age: 57 y; age range: 18-90 y). Contraindications for day-case surgery were identified preoperatively in 23% of the cases (39 of 168) and intraoperatively in another 23% of the cases. The proportion of patients hospitalized for <3 d was 41% (69 of 168) when considering the intention-to-treat population and 57% (51 of 90) when considering patients with no contraindications to day-case surgery. Forty percent of the patients hospitalized for ≥3 d (16 of 39) suffered from postoperative pain that was poorly controlled by oral analgesics. Abdominal drainage was the only predictive factor for hospitalization <3 d (odds ratio [95% confidence interval] = 0.13 [0.02-0.71]; P = 0.01).

CONCLUSIONS:

Day-case laparoscopic may be feasible in selected patients with mild or moderate acute calculous cholecystitis. Our present results may be of use in designing a study of day-case surgery for acute calculous cholecystitis and related changes in the management of these patients.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS:

Acute cholecystitis; Cholecystectomy; Day-case surgery

PMID:
24135378
[PubMed - indexed for MEDLINE]
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