Laparoscopic Cholecystectomy in Day Surgery

Abstract

Laparoscopic Cholecystectomy (LC) represents today the gold standard for the treatment of cholelithiasis. Despite the well known short post-operative course of laparoscopy in Italy today the mean hospital stay for LC is 2.6 days. Since november 2003 we have instituted in our Hospital a treatment protocol for cholelithiasis in Day Surgery. Our protocol includes patients up to 65 years of age, without major contraindications for the general anesthesia (ASA I or II) and no acute complications related to gall bladder stones. The surgical procedure usually starts at 8:00 am, we perform the LC with a 3 trocars technique with a mean duration of 40 minutes. After the intervention the patients come back to the ward and at 2 pm they are allowed to eat a soup and walk. At 4 pm serum RBC, Bilirubin, Amylase and Lipase are checked and at 6 pm they are discharged. From November 2003 to December 2009 we performed 150 LC: 46 men and 104 women. Mean age: 52 yrs (21- 65). Mean operative time 55 minutes (29- 85) with no open conversions. Patients were discharged 8-10 hours after the procedure. Five patients needed one night hospitalization, two for postoperative pain and three for PONV. The ambulatory LC is justificated by semplification of the procedures, reduction of hospitalization costs and also by a low impact in patients.