Genser L, Vons C
Service de chirurgie digestive, hôpital Jean-Verdier, AP-HP, hôpitaux universitaires de Seine-Saint-Denis, avenue du 14 Juillet, 93140 Bondy, France.
Service de chirurgie digestive, hôpital Jean-Verdier, AP-HP, hôpitaux universitaires de Seine-Saint-Denis, avenue du 14 Juillet, 93140 Bondy, France.
J Visc Surg. 2015 Dec;152(6 Suppl):S81-9. doi: 10.1016/j.jviscsurg.2015.09.015. Epub 2015 Oct 27.
The performance of emergency abdominal surgery in an outpatient setting is increasingly the order of the day in France. This review evaluates the feasibility and reliability of ambulatory surgical treatment of the most common abdominal emergencies: appendectomy for acute appendicitis and cholecystectomy for acute complications of gallstone disease (acute cholecystitis and gallstone pancreatitis).
This study evaluates surgical procedures performed on an ambulatory basis according to the international definition (admission in the morning, discharge in the evening with a hospital stay of less than 12 hours). Just as for elective surgery, eligibility of patients for an ambulatory approach depends on the capacities of the surgical and anesthesia team: to manage the risks, particularly the risk of deferring surgery until the morning); to prevent or treat post-operative symptoms like pain, nausea, vomiting, re-ambulation in order to permit rapid post-operative discharge.
Recent studies have shown that appendectomy for non-complicated acute appendicitis can be deferred for up to 12 hours without any increase in danger. Many other studies have shown that early discharge after appendectomy for acute non-complicated appendicitis is feasible and safe. Nonetheless, there is only one published series of truly ambulatory appendectomies. The results were excellent. Patients who presented in the afternoon were brought back for operation the following morning. The appropriate timing for performance of cholecystectomy in patients with acute calculous cholecystitis or gallstone pancreatitis has not been well defined, but is always somewhat delayed relative to the onset of symptoms. To minimize operative complications, cholecystectomy for acute calculous cholecystitis should probably be performed between 24 and 72 hours after diagnosis. Cholecystectomy for gallstone pancreatitis should probably not be delayed longer than a week; the need to keep the patient hospitalized during the interval has not been demonstrated. Early discharge after cholecystectomy was usually possible, even in series where acute cholecystitis was diagnosed intra-operatively. Cholecystectomy for acute cholecystitis and gallstone pancreatitis seems to be feasible but no reports specifically support this approach.
Emergency abdominal surgery seems to be feasible on an ambulatory setting for non-complicated acute appendicitis, acute calculous cholecystitis and gallstone pancreatitis. Only a single French series on ambulatory appendectomy for acute appendicitis has been reported.
在法国，门诊环境下进行急诊腹部手术日益成为常态。本综述评估了对最常见腹部急症进行门诊手术治疗的可行性和可靠性：急性阑尾炎行阑尾切除术，以及胆结石疾病急性并发症（急性胆囊炎和胆石性胰腺炎）行胆囊切除术。
本研究根据国际定义评估门诊手术操作（上午入院，晚上出院，住院时间少于12小时）。与择期手术一样，患者是否适合门诊手术方法取决于手术和麻醉团队的能力：管理风险，特别是将手术推迟到次日上午的风险；预防或治疗术后症状，如疼痛、恶心、呕吐、再次行走，以便术后能快速出院。
近期研究表明，非复杂性急性阑尾炎的阑尾切除术可推迟长达12小时而不增加任何危险。许多其他研究表明，急性非复杂性阑尾炎阑尾切除术后早期出院是可行且安全的。然而，仅有一个已发表的真正门诊阑尾切除术系列。结果非常好。下午就诊的患者于次日上午返回接受手术。对于急性结石性胆囊炎或胆石性胰腺炎患者，进行胆囊切除术的合适时机尚未明确界定，但相对于症状发作总是会有所延迟。为使手术并发症最小化，急性结石性胆囊炎的胆囊切除术可能应在诊断后24至72小时内进行。胆石性胰腺炎的胆囊切除术可能不应延迟超过一周；在此期间让患者住院的必要性尚未得到证实。胆囊切除术后早期出院通常是可能的，即使在术中诊断为急性胆囊炎的系列研究中也是如此。急性胆囊炎和胆石性胰腺炎的胆囊切除术似乎是可行的，但没有报告专门支持这种方法。
对于非复杂性急性阑尾炎、急性结石性胆囊炎和胆石性胰腺炎，门诊环境下进行急诊腹部手术似乎是可行的。仅报道了一个关于急性阑尾炎门诊阑尾切除术的法国系列研究。
