Coelho Júlio Cezar Uili, Dalledone Giuliano Ohde, Martins Filho Eduardo Lopes, Ramos Eduardo José Brommelstroet, Roeder da Costa Marco Aurélio, de Loyola E Silva Omar O H M
Department of Surgery. Hospital Nossa Senhora das Graças and Hospital de Clinicas. Federal University of Parana, Curitiba, Brazil.
JSLS. 2019 Apr-Jun;23(2). doi: 10.4293/JSLS.2019.00016.
In several developed countries, most laparoscopic cholecystectomies (LCs) are performed as an ambulatory operation (ALC) with a high rate of success. In Latin America, the experience with this procedure is still limited. Our objective is to evaluate the feasibility to implement ALC in a Brazilian teaching hospital.
Data obtained from electronic medical records and study protocols of all patients who underwent an LC between January 2011 and March 2018 were evaluated. All patients with chronic or acute cholecystitis were initially considered for an ALC.
Of a total of 1645 patients who underwent LC, 1577 (95.9%) were discharged on the same day of the operation. The main reasons for hospital admission after ALC were patient refusal to be discharged (n = 23; 1.4%), nausea and vomiting (n = 15; 0.9%), and complicated acute cholecystitis. No patient was excluded from consideration for ALC based only on age, history of previous upper abdominal operation, and presence of comorbidity. Patient age ranged from 12 to 100 years, with a mean of 50.23 ± 15.35 years. Intraoperative and postoperative complication rates were 0.4% and 5.5%, respectively. Most perioperative complications were because of technical surgical difficulties and complications common to most abdominal operations (surgical site, pulmonary, urinary, and venous complications). Thirteen (0.8%) patients were readmitted to the hospital because of abdominal pain and fever (n = 4), pneumonia (n = 3), deep venous thrombosis (n = 3), or urinary retention (n = 3).
ALC may be performed in Brazil with low rates of morbidity, mortality, and hospital readmission. Its implementation should be stimulated in Latin America.
在一些发达国家，大多数腹腔镜胆囊切除术（LC）作为门诊手术（ALC）开展，成功率很高。在拉丁美洲，该手术的经验仍然有限。我们的目的是评估在巴西一家教学医院实施ALC的可行性。
对2011年1月至2018年3月期间接受LC的所有患者的电子病历和研究方案中获取的数据进行评估。所有慢性或急性胆囊炎患者最初都被考虑进行ALC。
在总共1645例行LC的患者中，1577例（95.9%）在手术当天出院。ALC后住院的主要原因是患者拒绝出院（n = 23；1.4%）、恶心和呕吐（n = 15；0.9%）以及复杂性急性胆囊炎。没有患者仅因年龄、既往上腹部手术史和合并症而被排除在ALC考虑范围之外。患者年龄从12岁到100岁不等，平均年龄为50.23±15.35岁。术中及术后并发症发生率分别为0.4%和5.5%。大多数围手术期并发症是由于手术技术困难以及大多数腹部手术常见的并发症（手术部位、肺部、泌尿系统和静脉并发症）。13例（0.8%）患者因腹痛和发热（n = 4）、肺炎（n = 3）、深静脉血栓形成（n = 3）或尿潴留（n = 3）再次入院。
在巴西可以开展ALC，其发病率、死亡率和再入院率较低。应在拉丁美洲推动其实施。
