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[Intraoperative factors predictive of failure of the ambulatory regimen after laparoscopic cholecystectomy]
José Bueno-Lledó1, Manuel Planells-Roig, Angel Sanahuja-Santafé
1Servicio de Cirugía, Instituto de Cirugía General y del Aparato Digestivo, ICAD, Clínica Quirón, Valencia, Spain.
Objectives:
To determine which intraoperative factors during ambulatory laparoscopic cholecystectomy predict postoperative admission.
Material And Method:
Between January 1999 and August 2003, we attempted 410 consecutive laparoscopic cholecystectomies. Intraoperative variables were analyzed using univariate and multivariate methods. An intraoperative score was applied to determine the probability of successful ambulatory surgery in each patient.
Results:
A total of 88.5% of the patients were strictly ambulatory. Forty-two patients required overnight admission, mostly due to social factors, and five patients required admission after 24-48 hours. Intraoperative variables predictive of postoperative admission were an operating time of more than 60 minutes (p = 0.011), gallbladder dissection with anatomic difficulty (p = 0.001), and cystic artery hemorrhage (p = 0.041). Surgical access to the abdominal cavity, gallbladder perforation, trocar wound or hepatic bed bleeding, intensity or grade of hemorrhage, and gallbladder extraction were not predictive variables.
Conclusions:
Ambulatory laparoscopic cholecystectomy is a safe and effective procedure. Operating time, correct dissection of gallbladder structures and hemorrhage of the gallbladder hilus, especially of the cystic artery, play a major role in the success or failure of ambulatory laparoscopic cholecystectomy.
