Abstracts
1998 Digestive Disease Week

#2323

LAPAROSCOPIC CHOLECYSTECTOMY AS A "TRUE" OUTPATIENT PROCEDURE: INITIAL EXPERIENCE IN 100 CONSECUTIVE PATIENTS. KD Lillemoe, JM Hardacre, MA Talamini, CJ Yeo, DS Snyder, SD Parker. Depts of Surgery and Anesthesiology, The Johns Hopkins Medical Institutions, Baltimore, MD.

Laparoscopic cholecystectomy has been well documented to reduce the length of hospitalization and postoperative disability when compared to open cholecystectomy. Many centers have employed "short-stay" units or "23 hour admissions" for postoperative observation following laparoscopic cholecystectomy. However, the practice of early discharge as "true" outpatients following this procedure has not been well defined. Methods: Between April, 1996 and December 1997, inclusive, 100 consecutive patients underwent laparoscopic cholecystectomy in an outpatient surgery unit affiliated with a university health center. All patients underwent standard laparoscopic cholecystectomy with CO2 insufflation. General anesthesia was maintained using propofol, nitrous oxide, fentanyl, and mivacurium. Ketorolac was administered intravenously and bupivacaine injected over the dome of the liver and at port sites for pain control. Odansetron was given intravenously prior to induction of anesthesia. Patients were discharged to home after meeting standard criteria (i.e. able to sit, stand, ambulate, void, and tolerate oral fluids). Results: One hundred consecutive patients underwent laparoscopic cholecystectomy with the intent of early discharge to home. No patient required conversion to an open procedure and only one intraoperative complication was recognized (trochar site bleeding). There were 78 women with a mean age of 46.8 years (range 21-76 years). All patients were ASA Class I (52%), II (36%) or III (12%). The mean operative time was 1.1 ± 0.3 hours (range .5 - 1.8 hours). Ninety-five patients were discharged to home after recovery from the procedure at a mean of 192 ± 7 min (range 95 - 425 min). Four of five patients that required hospital admission on the day of surgery for either failure to meet discharge criteria or further observation were discharged the following morning. Four patients were readmitted to the hospital after discharge to home on POD # 1, 1, 3, and 4 for diagnoses of intractable nausea and vomiting (2 patients), right upper quadrant pain/constipation (1 patient), and a bile leak from the gallbladder bed (1 patient). Three of these four patients were discharged after only one day of hospitalization. Conclusions: Laparoscopic cholecystectomy can be performed as a "true" outpatient procedure with patients discharged to home within a few hours of completion of the procedure. Approximately 10% of patients may fail this protocol and require hospital admission but without adverse sequelae associated with the outpatient setting.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.