Cargando…

Cholécystectomie laparoscopique ambulatoire: première expérience en Tunisie

INTRODUCTION: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstones. There is some debate as to whether it should be performed in outpatient surgery or in one-day surgery to improve patient safety. This study aimed to evaluate the impact of laparoscopic cholecystecto...

Descripción completa

Detalles Bibliográficos
Autores principales: Zaafouri, Haithem, Mrad, Skander, Khedhiri, Nizar, Haddad, Dhafer, Bouhafa, Ahmed, Maamer, Anis Ben
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The African Field Epidemiology Network 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724953/
https://www.ncbi.nlm.nih.gov/pubmed/29255548
http://dx.doi.org/10.11604/pamj.2017.28.78.9564
_version_ 1783285446810271744
author Zaafouri, Haithem
Mrad, Skander
Khedhiri, Nizar
Haddad, Dhafer
Bouhafa, Ahmed
Maamer, Anis Ben
author_facet Zaafouri, Haithem
Mrad, Skander
Khedhiri, Nizar
Haddad, Dhafer
Bouhafa, Ahmed
Maamer, Anis Ben
author_sort Zaafouri, Haithem
collection PubMed
description INTRODUCTION: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstones. There is some debate as to whether it should be performed in outpatient surgery or in one-day surgery to improve patient safety. This study aimed to evaluate the impact of laparoscopic cholecystectomy performed in outpatient surgery versus one-day surgery on standards such as mortality, serious adverse events and quality of life. METHODS: We conducted a cross-sectional descriptive study in the Department of General Surgery at the Habib Thameur Hospital over the period May 2009-February 2010. We here report 67 cases of symptomatic vesical lithiasis treated with outpatient laparoscopic cholecystectomy (OLC). ASA III and IV patients, diabetic patients treated with sulfonamides or insulin, severely obese patients, patients over 65 years of age and under 18 years of age, patients with a history of major abdominal surgery, patients with suspected lithiasis of the common bile duct, acute cholecystitis or pancreatitis were excluded from the study. Patients had to reside within 50 km of the hospital and be accompanied by an adult to undergo OLC. RESULTS: Seventeen patients were included and then excluded from our study because of the perioperative detection of signs of acute cholecystitis or difficulties in dissection leading to subhepatic drainage using Redon catheter at the end of the intervention. Finally, our study included 50 patients, 7 men and 43 women; the average age was 48 years. Surgery was based on the most common procedures. After leaving the recovery room, patients were conducted in the outpatient sector where they received a liquid diet. The patients were examined before 7 o’clock in the evening and discharge was established on the basis of the possibility of establishing an oral analgesic treatment, patients tolerance to liquid diet, the lack of urinary disorder, patients acceptance for discharge and analgesic and anti-inflammatory treatment if needed. Thirty-nine patients (78%) were discharged from hospital and 11 were kept in hospital. Patients > 45 years of age, anesthesia duration > 70 minutes and post operative fatigue were identified as risk factors for unsuccessful discharge. No readmission was observed. Discharged patients were satisfied with the therapeutic protocol, resulting in excellent and good outcome in the majority of cases (94%). CONCLUSION: Outpatient laparoscopic cholecystectomy seems to be as safe as day surgery laparoscopic cholecystectomy having low rate of complications and of hospital readmissions in some selected patients and lower surgery costs.
format Online
Article
Text
id pubmed-5724953
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher The African Field Epidemiology Network
record_format MEDLINE/PubMed
spelling pubmed-57249532017-12-18 Cholécystectomie laparoscopique ambulatoire: première expérience en Tunisie Zaafouri, Haithem Mrad, Skander Khedhiri, Nizar Haddad, Dhafer Bouhafa, Ahmed Maamer, Anis Ben Pan Afr Med J Research INTRODUCTION: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstones. There is some debate as to whether it should be performed in outpatient surgery or in one-day surgery to improve patient safety. This study aimed to evaluate the impact of laparoscopic cholecystectomy performed in outpatient surgery versus one-day surgery on standards such as mortality, serious adverse events and quality of life. METHODS: We conducted a cross-sectional descriptive study in the Department of General Surgery at the Habib Thameur Hospital over the period May 2009-February 2010. We here report 67 cases of symptomatic vesical lithiasis treated with outpatient laparoscopic cholecystectomy (OLC). ASA III and IV patients, diabetic patients treated with sulfonamides or insulin, severely obese patients, patients over 65 years of age and under 18 years of age, patients with a history of major abdominal surgery, patients with suspected lithiasis of the common bile duct, acute cholecystitis or pancreatitis were excluded from the study. Patients had to reside within 50 km of the hospital and be accompanied by an adult to undergo OLC. RESULTS: Seventeen patients were included and then excluded from our study because of the perioperative detection of signs of acute cholecystitis or difficulties in dissection leading to subhepatic drainage using Redon catheter at the end of the intervention. Finally, our study included 50 patients, 7 men and 43 women; the average age was 48 years. Surgery was based on the most common procedures. After leaving the recovery room, patients were conducted in the outpatient sector where they received a liquid diet. The patients were examined before 7 o’clock in the evening and discharge was established on the basis of the possibility of establishing an oral analgesic treatment, patients tolerance to liquid diet, the lack of urinary disorder, patients acceptance for discharge and analgesic and anti-inflammatory treatment if needed. Thirty-nine patients (78%) were discharged from hospital and 11 were kept in hospital. Patients > 45 years of age, anesthesia duration > 70 minutes and post operative fatigue were identified as risk factors for unsuccessful discharge. No readmission was observed. Discharged patients were satisfied with the therapeutic protocol, resulting in excellent and good outcome in the majority of cases (94%). CONCLUSION: Outpatient laparoscopic cholecystectomy seems to be as safe as day surgery laparoscopic cholecystectomy having low rate of complications and of hospital readmissions in some selected patients and lower surgery costs. The African Field Epidemiology Network 2017-09-27 /pmc/articles/PMC5724953/ /pubmed/29255548 http://dx.doi.org/10.11604/pamj.2017.28.78.9564 Text en © Haithem Zaafouri et al. http://creativecommons.org/licenses/by/2.0/ The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Zaafouri, Haithem
Mrad, Skander
Khedhiri, Nizar
Haddad, Dhafer
Bouhafa, Ahmed
Maamer, Anis Ben
Cholécystectomie laparoscopique ambulatoire: première expérience en Tunisie
title Cholécystectomie laparoscopique ambulatoire: première expérience en Tunisie
title_full Cholécystectomie laparoscopique ambulatoire: première expérience en Tunisie
title_fullStr Cholécystectomie laparoscopique ambulatoire: première expérience en Tunisie
title_full_unstemmed Cholécystectomie laparoscopique ambulatoire: première expérience en Tunisie
title_short Cholécystectomie laparoscopique ambulatoire: première expérience en Tunisie
title_sort cholécystectomie laparoscopique ambulatoire: première expérience en tunisie
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724953/
https://www.ncbi.nlm.nih.gov/pubmed/29255548
http://dx.doi.org/10.11604/pamj.2017.28.78.9564
work_keys_str_mv AT zaafourihaithem cholecystectomielaparoscopiqueambulatoirepremiereexperienceentunisie
AT mradskander cholecystectomielaparoscopiqueambulatoirepremiereexperienceentunisie
AT khedhirinizar cholecystectomielaparoscopiqueambulatoirepremiereexperienceentunisie
AT haddaddhafer cholecystectomielaparoscopiqueambulatoirepremiereexperienceentunisie
AT bouhafaahmed cholecystectomielaparoscopiqueambulatoirepremiereexperienceentunisie
AT maameranisben cholecystectomielaparoscopiqueambulatoirepremiereexperienceentunisie