Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est-UPEC, Address: 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
UMR INSERM U1086 Cancers et Prevention, Centre François Baclesse, Avenue du Général Harris, 14045, Caen Cedex, France.
Surg Endosc. 2017 Nov;31(11):4458-4465. doi: 10.1007/s00464-017-5498-9. Epub 2017 Apr 4.
Technical advances in laparoscopy and enhanced recovery after surgery programs have progressively decreased the need for hospitalization. The present study aimed to explore the feasibility and safety of an early discharge protocol after minor laparoscopic liver resection (LLR).
The study sample consisted of patients with both benign and malignant hepatic lesions involving no more than two hepatic segments who underwent minor LLR and were discharged within 24 h. Patients were selected based on their fitness for surgery, proximity to the hospital, and availability of a responsible adult to care for them once discharged. Patients and their accompanying caregiver were instructed about the procedure, its potential complications, and the conditions required for an early discharge. They were also provided with a 24-h dedicated phone number for assistance.
Twenty-four patients [mean age 48.9 year (SD 14.75); 12 women] with no more than one comorbidity were included. The majority (87.5%) was classified as ASA I or II. Thirteen patients (46%) were operated on for malignant lesions. The median operative time was 90 min, the median pneumoperitoneum time was 60 min, and the estimated blood loss was 50 mL. Mortality was zero. No transfusion, conversion, or pedicule clamping was necessary. No anesthesia-related complications occurred. All patients were discharged at 24 h. Only one patient (4.2%) was readmitted at postoperative day 3 for intolerable abdominal pain due to a wound abscess that was treated by antibiotics.
By applying a standardized protocol for admission, preoperative workup, and anesthesia, early discharge after minor LLR can be successfully carried out in highly selected patients with minimal impact on primary healthcare services.
腹腔镜技术和术后加速康复方案的进步逐渐降低了住院需求。本研究旨在探讨小切口腹腔镜肝切除术（LLR）后实施早期出院方案的可行性和安全性。
本研究样本包括接受小切口 LLR 且 24 小时内出院的良性和恶性肝病变患者，累及不超过两个肝段。根据手术适应情况、与医院的距离以及出院后负责照顾患者的成年家属的可用性选择患者。向患者及其陪护人员介绍手术过程、潜在并发症以及早期出院所需的条件。还为他们提供了 24 小时专用电话号码以获取帮助。
共纳入 24 例患者（平均年龄 48.9 岁，标准差 14.75 岁；12 名女性），合并症不超过 1 种。大多数患者（87.5%）为 ASA I 或 II 级。13 例（46%）患者因恶性病变接受手术。中位手术时间为 90 分钟，中位气腹时间为 60 分钟，估计出血量为 50 毫升。无死亡病例，无输血、中转开腹或血管阻断。无麻醉相关并发症。所有患者均于 24 小时出院。仅 1 例患者（4.2%）因术后 3 天无法忍受的腹痛（伤口脓肿，经抗生素治疗）再次入院。
通过应用入院、术前检查和麻醉的标准化方案，可以在对初级医疗保健服务影响最小的情况下，成功为高度选择的小切口 LLR 后患者实施早期出院。
