Outpatient laparoscopic laser cholecystectomy

Article Abstract:

With more and more attention being paid to the increasing costs of medical care, efforts are being made to determine if some major surgery can be performed on an outpatient basis. Cholecystectomy (surgical removal of the gallbladder), one of the most commonly performed operations, can now be performed with the use of laser energy. This approach, known as laparoscopic laser cholecystectomy, usually permits the patient to be discharged from the hospital the day after surgery, a significant reduction in hospital stay from the traditional open surgical procedure. A report is presented of the use of the laparoscopic laser cholecystectomy on 83 patients. Thirty-seven patients were treated on an outpatient basis not requiring an overnight stay in the hospital; the outpatient group represented 45 percent of the patients operated on. The average age of the outpatient group was younger, at 39, than the average age of 46 years for the inpatient group. The average weight of the outpatients was slightly lower than that of the inpatient group (155 pounds versus 162). The hospital charges for the traditional inpatient cholecystectomy at this particular hospital are $4,416 on average, compared with $3,600 for inpatient laparoscopic laser cholecystectomy, and $3,200 for outpatient laparoscopic laser cholecystectomy. The authors found that half of the patients evaluated were eligible for the outpatient procedure, but only 45 percent chose this option. The main obstacle to outpatient surgery was patient resistance, often influenced by the knowledge that other patients had required long hospitalizations for cholecystectomy, or by concern about lack of home care during the postoperative period. With further education, more patients can undergo outpatient cholecystectomy. An editorial comment notes that new surgical treatments may need further refinement, and specific training in the procedure is required. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Economic aspects, Lasers in surgery, Laser surgery, Gallbladder, Surgery, Outpatient, Ambulatory surgery

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Simple elective cholecystectomy: to drain or not

Article Abstract:

Cholecystectomy (removal of the gallbladder) is the second most commonly performed abdominal operation. At the time of surgery, in order to drain excess fluid and avoid peritonitis (inflammation of the membrane surrounding the abdominal organs) and fluid collection beneath the liver, a drain is traditionally used. There is no agreement whether this should be done routinely; surgery performed without its use has been claimed to have fewer complications and an easier recovery and shorter hospital stay for the patient. A prospective study was performed of patients undergoing elective cholecystectomy. Drains were not used for 248 patients; a closed suction (Hemovac) drain was used for 122 patients; and 124 had regular Penrose drain placed. The results were that no patients died or needed reoperation. Wound infections occurred in 3 percent of patients with little difference between those with or without drains; infection occurred in 8 patients with drains and 6 without. In patients who had drains placed, the volume of fluid drained was small and only 4 percent of patients had prolonged drainage. There were no differences between patients without drainage and those having short-term drains drainage in terms of pulmonary (lung) complications or postoperative hospital stay. These results indicate that it is safe to eliminate drain use for patients undergoing simple elective cholecystectomy. A statistical analysis performed on ten previously reported studies involving over 1,900 patients reveals a similar finding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Drainage, Surgical, Drainage (Surgical), Hemovac (Medical instrument)

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Complications of laparoscopic cholecystectomy

Article Abstract:

Laparoscopic cholecystectomy, a new technique for removal of the gallbladder, has been enthusiastically received by general surgeons. This is a minimally invasive procedure carried out through four small (1/2 inch or smaller) abdominal incisions. The gallbladder is removed under laparoscopic visualization (images from an illuminated optic instrument placed within the abdomen are displayed on a video monitor). Laparoscopic cholecystectomy is not without complications. A clear relationship has been found between the experience of the surgeon and complications; as the learning curve progresses, complications decline. Many surgeons are being trained in this new technique, but most practitioners have performed fewer than 50 of the procedures, and there are scarcely any reports of large studies of this new technique. Although early reports on this technique are encouraging, the potential complications include bile duct injury and hemorrhage. To avoid complications, it is important for the surgeon to pay careful attention to detail and be ready to convert from laparoscopic to open abdominal surgery when indicated. Whenever possible, cholangiography (X-ray examination of the bile ducts) should be done. Patients should be selected carefully for this procedure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Abdomen, Laparotomy, Laparoscopy

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