Laparoscopic cholecystectomy in the treatment of biliary lithiasis: outpatient surgery or short stay unit? A. Martínez Vieira, F. Docobo Durántez, J. Mena Robles. Abstract. MOORE, John Henry et al. Ambulatory laparoscopic cholecystectomy: a cost-efficient model of laparoscopic surgery. rev. colomb. cir. [online]. Download Citation on ResearchGate | Colecistectomía laparoscópica ambulatoria | SUMMARY Objective: We present our experience in lap- aroscopic .
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But this advance means it will be necessary for patients to have a longer period of recovery, with a subsequent increase in costs. The level of complexity of procedures that can be carried out in a DSU is increasing. Cir Esp ; Laparoscopic surgery entailed a number of nowadays universally accepted benefits for patients. One of the most commonly used markers is the rate of events and complications arising during the postoperative period 9.
However, it should be noted that scientific evidence supporting its superiority versus traditional cholecystectomy as based upon controlled randomized studies is pretty scant, regardless its wide acceptance by the health-care community and patients as well. A prospective, randomized, single-blind study.
Comprehensive information and patient individualization are efficient and valid measures to prevent admissions for social reasons doubt and insecurity of patients at discharge. All these patients were potential candidates for outpatient treatment.
Thus, not only has laparoscopy advanced in itself, but traditional techniques have also benefited from greater rigor in outcome studies, and healthy competition has shown up regarding “lesser invasion” with increasingly small incisions, and shorter stays and postoperative periods, all of which represents great value for patients.
A prevention of such incidents is the best way to avoid hospital stays. The only efficient way to prevent these hospital stays is comprehensive information and patient individualization.
This is, in our view, a scarcely mentioned benefit of daily-care LC, since a significant improvement in procedural quality most likely occurs through the specialization of team members and the careful care needed for early discharge. Although many comparative studies exist on all sorts of partial aspects that clear-ly reveal the benefits of LC -from classic morbidity and mortality, and hospital stay studies to sophisticated studies on- say -post-procedural immune response- only two prospective, randomized, single-blind studies compared laparoscopic versus open cholescystectomy 1,2and none showed clearly significant differences for either procedure.
Rev And Pat Digest ; All patients followed laparoscopkca normal procedures establi-shed by the DSU: Similarly, a small number of failures from intra- or postoperative complications exist, which will diminish as experience is gain-ed in both patient selection and surgical, anesthetic and nursing management scheduling. Other complications that lead to unexpected extension of the hospital stays bleeding, drainage, etc.
Lau H, Brooks DC. Eighty one out of 91 patients who underwent laparoscopic cholecystectomy during year have been included in this study. One group performed the procedure habitually and on an outpatient basis in most cases, whereas the other group performed the technique rather sporadically among their scheduled standard procedures.
To evaluate the latter dolecistectomia it is necessary to focus on morbidity markers and quality as colecisetctomia by patients 8. A prophylactic antibiotic, cefazoline, was administered, and a dressing was applied to the lower limbs of patients with distal vein problems or obesity.
Colecistectomía laparoscópica y cirugía ambulatoria
But quality management is as important regarding “offered quality” as regarding “perceived quality”, and this is often harder to convey so that early discharged patients perceive it, be it because of fear even in the absence of complications or because of a magnification of events that obviously might also have developed should the patient have stayed in hospital.
The problem is that bladder and bile duct motility is difficult to acknowledge in daily practice 7and disorders may be in combination with other gastrointestinal motility abnormalities 8.
Regarding other surgical procedures habitually included in MOS, LC has the differential characteristic of being a technique requiring general anesthesia for an approach of the peritoneal cavity.
Compared to inpatient surgery, it reduces the time a patient spends in hospital and therefore entails less interference in daily and working life 4. Tratamiento de la hernia inguinocrural. Laparoscopic cholecystectomy has been improved in such a way that, used in the treatment of non-complicated biliary lithiasis, it has become a part of the service offered by the SSS units and, nowadays, by the DSUs 2,3.
Retrospective and comparative study between two groups: From what emerges from our study, and from data offered by other authors 10,11early postsurgical events bleeding, vomiting, etc.
Rev Esp Enferm Dig ; If these conditions are theoretically present in DSU as well as in SSS units, which factors will determine hospital stay and what makes a difference between both types of programs?
Regarding laparoscopic cholecystectomy LCthis procedure evolved in 6 years -from the time is was first used back in to become the gold-standard in the treatment of symptomatic cholethiasis.
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Ann Surg ; The aim of the present study was to analyse clinical and surgical factors in patients who underwent laparoscopic cholecystectomy in a DSU, which could be determinants in deciding to discharge patients on the same day of the procedure DSU programme or to discharge them after 24 hours of hospital stay SSS Unit. When it is necessary for patients to have a recovery period of more than 24 hours in hospital, with the subsequent increase in costs, we are faced with the concept known as Short Stay Surgery SSS.
The latter authors reported in on their experience along 4 years of outpatient LC in this same journal 5and were understandably considered a pioneer group for LC in MOS in our country. Overall experience regarding LC in MOS is consistent with observations in other techniques, laparoscopicaa is, that greater expertise in a procedure and its common daily-care use improve results. The same goes for private surgery, but regarding public health-care, a universal, free-of-charge model such as the Spanish one is mainly concerned in hospital stay reduction in addition to reduced costs per procedure, in an attempt to free hospital beds for other procedures and send patients home upon surgery completion.
All these reasons together with a lack of perception of financial benefits by patients render day-care surgery more difficult to implement and colecisteectomia presence uneven. Gallbladder motility and functional disorders. Postgrad Med J ; Anyway, patients preoperatively labeled as colecistectoomia alithiasic cholecystopathies are overall excellent candidates to outpatient LC, at least regarding a lower likeliness of complicated surgical procedures. Can laparoscopic cholecystectomy be a day surgery procedure.
Laparoscopic cholecystectomy in the treatment of biliary lithiasis: Its feasibility has been demonstrated in all settings and differing countries with rather similar results The experience of the surgeon who operates and discharges the patient is also important, as is that of all team involved in the unit, especially since the greater percentage of patients who remained in hospital had been operated on coleciistectomia the first months of In fact, initial distrust regarding this way of surgery has led to a careful analysis of colecistecttomia results which we are convinced was unparalleled before for surgical techniques.
It is basically determined by the traditional belief that a longer period of health care provides better results than an outpatient regimen. We would like to stop here at any rate to superficially analyze concept differences amongst cultures and health-care models with respect to major outpatient surgery MOS. Variables lapqroscopica as doubt or insecurity of patients at discharge can be important factors when it comes to deciding on admission.
