Marinis Athanasios, Stamatakis Emmanouil, Tsaroucha Athanasia, Dafnios Nikolaos, Anastasopoulos Georgios, Polymeneas Georgios, Theodosopoulos Theodosios
Second Department of Surgery Aretaieion University Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 76 Vassilisis Sofia's Ave, 11528, Athens, Greece.
BMC Res Notes. 2010 Jul 22;3:207. doi: 10.1186/1756-0500-3-207.
The aim of this study was to evaluate the safety and efficacy of outpatient laparoscopic cholecystectomy (OLC) in a day surgery unit in a teaching hospital. OLC was offered to patients with symptomatic cholelithiasis who met the following established inclusion criteria: ASA (American Society of Anesthesiology) physical status classification class I and II; age: 18 - 70 years; body mass index (BMI) < 30 kg/m2; patient acceptance and cooperation (informed consent); presence of a responsible adult to accompany the patient to his residency; patient residency in Athens. The primary study end-point was to evaluate success rates (patient discharge on the day of surgery), postoperative outcome (complications, re-admissions, morbidity and mortality) and patient satisfaction. A secondary endpoint was to evaluate its safe performance under appropriate supervision by higher surgical trainees (HSTs).
110 consecutive patients, predominantly female (71%) and ASA I (89%) with a mean age 40.6 +/- 8.1 years underwent an OLC. Surgery was performed by a HST in 90 patients (81.8%). A mean postoperative pain score 3.3 (range 0-6) occurred in the majority of patients and no patient presented postoperative nausea or vomiting. Discharge on the day of surgery occurred in 95 cases (86%), while an overnight admission was required for 15 patients (14%). Re-admission following hospital discharge was necessary for 2 patients (1.8%) on day 2, due to persistent pain in the umbilical trocar site. The overall rate of major (trocar site bleeding) and minor morbidity was 15.5% (17 patients). At 1 week follow-up, 94 patients (85%) were satisfied with their experience undergoing OLC, with no difference between grades of operating surgeons.
This study confirmed that OLC is clinical effective and can be performed safely in a teaching hospital by supervised HSTs.
本研究旨在评估教学医院日间手术单元中门诊腹腔镜胆囊切除术（OLC）的安全性和有效性。符合以下既定纳入标准的有症状胆石症患者可接受OLC：美国麻醉医师协会（ASA）身体状况分级为I级和II级；年龄：18 - 70岁；体重指数（BMI）< 30 kg/m²；患者接受并配合（知情同意）；有责任成年人陪同患者返回居住地；患者居住在雅典。主要研究终点是评估成功率（手术当天出院）、术后结果（并发症、再次入院、发病率和死亡率）以及患者满意度。次要终点是评估在高级外科住院医师（HSTs）适当监督下其安全性能。
110例连续患者接受了OLC，其中大多数为女性（71%），ASA I级（89%），平均年龄40.6 +/- 8.1岁。90例患者（81.8%）由HST进行手术。大多数患者术后平均疼痛评分为3.3（范围0 - 6），无患者出现术后恶心或呕吐。95例患者（86%）在手术当天出院，15例患者（14%）需要过夜住院。2例患者（1.8%）在出院后第2天因脐部套管针部位持续疼痛而再次入院。主要（套管针部位出血）和轻微发病率的总体发生率为15.5%（17例患者）。在1周随访时，94例患者（85%）对接受OLC的经历感到满意，不同级别的手术医生之间无差异。
本研究证实OLC临床有效，并且在教学医院中由受监督的HSTs可以安全地进行。
