Colecistectomia laparoscópica em regime ambulatorial

Ramos, Almino Cardoso; Sallett, José Afonso; Lombardi, Monetti Maria; Tanikawa, Daniela Yukie Sakai; Martino, Rodrigo Bronze de; Zilberstein, Bruno

doi:10.1590/S0100-69911998000100003

Resumos

Durante o período de janeiro de 1994 a janeiro de 1997 foram submetidos ao método 120 pacientes, sendo 42 do sexo masculino (35%) e 78 do sexo feminino (65%). A idade variou de 16 a 60 anos, com média de 38. Todos apresentavam diagnóstico de colecistite calculosa crônica, sendo selecionados em consultório pelos seguintes critérios: inexistência de quadro inflamatório agudo da vesícula biliar, idade máxima de 60 anos, ausência de suspeita de coledocolitíase e classificação anestésica ASA I e II. A cirurgia era realizada em posição semiginecológica com utilização de três trocartes, sendo a colangiografia realizada de rotina. O tempo cirúrgico variou de 20 a 80 minutos com média de 50 minutos. A colangiografia intra-operatória foi realizada em 105 pacientes (87,5%), demonstrando coledocolitíase em dois (1,9%). Não ocorreram conversões. As complicações pós-operatórias imediatas mais freqüentes foram náuseas em oito casos (6,6%), seguidas de vômitos em dois pacientes (1,6%). A dor foi de pequena intensidade e facilmente controlável com dipirona e antiintlamatórios não-hormonais. Não ocorreram casos de infecção de ferida cirúrgica, mas três pacientes (2,5%) apresentaram hiperemia da incisão umbilical. Todos tiveram condições de alta no mesmo dia da cirurgia. O período de permanência hospitalar foi em média de 10 horas. Não houve necessidade de reinternação em nenhum caso.

Colecistectomia laparoscópica; Laparoscopia; Cirurgia ambulatorial; Tempo de internação

The arrival of cholecystectomy by minilaparotomy provided reduction of the hospitalar stay and the discharge on the same day began to be considered and applied with success to some patients. However, it was with the laparoscopic approach that the ambulatory surgery received strong stimulation. The feasibility of cholecystectomy for calculous chronic cholecystitis under laparoscopy in the outpatient ambulatory setting was evaluated in a prospective study. During the period between January 1994 to January 1997,120 patients were operated. Forty-two were male (35%) and 78 female (65%), aging from 16 to 60 at an average of 38. The patients were selected under the following criteria: no accute process, maximum age 60 years, no suspicion of choledocolithiasis and classification ASA I and 11. The surgery was performed in lithotomy position with three trocars. Cholangiography was routine. Surgical time ranged from 20 to 80 minutes with an average of 50. Cholangiography was done in 105 cases (87.5%) confirming choledocolithiasis in two (1.9%). There were no conversions. The most common complications in the imediate postoperative period were: nausea in eight patients (6.6%) with vomiting in two (1.6%). The abdominal pain was little and easily treated with dipiron and nonsteroidal antiinflammatory analgesics. Operatory wound infection was not observed but three patients (2.5%) showed hyperemia in the umbilical incision. All patients were discharged from ambulatory after an average hospitalar stay of ten hours. In conclusion, according to what this study has shown laparoscopic cholecystectomy can perfectly be done in the ambulatory setting without increasing on the complication rates.

Laparoscopic cholecystectomy; Laparoscopy; Ambulatory surgery; Length of stay

ARTIGOS ORIGINAIS

Colecistectomia laparoscópica em regime ambulatorial

Laparoscopic cholecystectomy in the outpatient on ambulatory setting

Almino Cardoso Ramos, TCBC-SP^I; José Afonso Sallett^I; Monetti Maria Lombardi^II; Daniela Yukie Sakai Tanikawa^III; Rodrigo Bronze de Martino^III; Bruno Zilberstein, TCBC-SP^IV

^IDiretor do Serviço

^IIAnestesista

^IIIAcadêmico estagiário

^IVDiretor do Serviço. Professor Livre-Docente da Disciplina de Cirurgia do Aparelho Digestivo da FMUSP

^{Endereço para correspondência} Endereço para correspondência: Dr. Almino Cardoso Ramos Av. Brasil, 703 01431-000 - São Paulo - SP

RESUMO

Durante o período de janeiro de 1994 a janeiro de 1997 foram submetidos ao método 120 pacientes, sendo 42 do sexo masculino (35%) e 78 do sexo feminino (65%). A idade variou de 16 a 60 anos, com média de 38. Todos apresentavam diagnóstico de colecistite calculosa crônica, sendo selecionados em consultório pelos seguintes critérios: inexistência de quadro inflamatório agudo da vesícula biliar, idade máxima de 60 anos, ausência de suspeita de coledocolitíase e classificação anestésica ASA I e II. A cirurgia era realizada em posição semiginecológica com utilização de três trocartes, sendo a colangiografia realizada de rotina. O tempo cirúrgico variou de 20 a 80 minutos com média de 50 minutos. A colangiografia intra-operatória foi realizada em 105 pacientes (87,5%), demonstrando coledocolitíase em dois (1,9%). Não ocorreram conversões. As complicações pós-operatórias imediatas mais freqüentes foram náuseas em oito casos (6,6%), seguidas de vômitos em dois pacientes (1,6%). A dor foi de pequena intensidade e facilmente controlável com dipirona e antiintlamatórios não-hormonais. Não ocorreram casos de infecção de ferida cirúrgica, mas três pacientes (2,5%) apresentaram hiperemia da incisão umbilical. Todos tiveram condições de alta no mesmo dia da cirurgia. O período de permanência hospitalar foi em média de 10 horas. Não houve necessidade de reinternação em nenhum caso.

Unitermos: Colecistectomia laparoscópica; Laparoscopia; Cirurgia ambulatorial; Tempo de internação.

ABSTRACT

The arrival of cholecystectomy by minilaparotomy provided reduction of the hospitalar stay and the discharge on the same day began to be considered and applied with success to some patients. However, it was with the laparoscopic approach that the ambulatory surgery received strong stimulation. The feasibility of cholecystectomy for calculous chronic cholecystitis under laparoscopy in the outpatient ambulatory setting was evaluated in a prospective study. During the period between January 1994 to January 1997,120 patients were operated. Forty-two were male (35%) and 78 female (65%), aging from 16 to 60 at an average of 38. The patients were selected under the following criteria: no accute process, maximum age 60 years, no suspicion of choledocolithiasis and classification ASA I and 11. The surgery was performed in lithotomy position with three trocars. Cholangiography was routine. Surgical time ranged from 20 to 80 minutes with an average of 50. Cholangiography was done in 105 cases (87.5%) confirming choledocolithiasis in two (1.9%). There were no conversions. The most common complications in the imediate postoperative period were: nausea in eight patients (6.6%) with vomiting in two (1.6%). The abdominal pain was little and easily treated with dipiron and nonsteroidal antiinflammatory analgesics. Operatory wound infection was not observed but three patients (2.5%) showed hyperemia in the umbilical incision. All patients were discharged from ambulatory after an average hospitalar stay of ten hours. In conclusion, according to what this study has shown laparoscopic cholecystectomy can perfectly be done in the ambulatory setting without increasing on the complication rates.

Key words: Laparoscopic cholecystectomy; Laparoscopy; Ambulatory surgery; Length of stay.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 22/4/97

Aceito para publicação em 15/9/97

Trabalho realizado no Instituto de Diagnóstico e Tratamento Avançado em Gastroenterologia e Coloproctologia - GASTROMED.

1. Ferraz EM, Bacelar TS, Melo E, et al. Cholecystectomy by minilaparotomy on an outpatient basis: an analysis of 36 patients. Braz Arch Dig Surg 1992;7:47-50.
2. Miller TA. Laparoscopic cholecystectomy: passing fancy or legitimate treatment option? Gastroenterology 1990;99:1.527-1.529.
3. Orlando R 3rd, Russell JC. Managing gallbladder disease in a cost-effective manner. Surg Clin North Am 1996;76(1):117-128.
4. Langenbuch CE. Fall von extirpation der gallenblase wegen chronischer cholelitiasis. Klin Wochenschr 1882:725.
5. Goco IR, Chambers LG. Mini-cholecystectomy and operative cholangiography . A means of cost containment. Am Surg 1983; 49: 143 -145.
6. Gerber A. An appraisal of paralytic ileus and the necessity of postoperative gastrointestinal suction. Surg Gynecol ObsteI 1963; 117:294-296.
7. Maull K, Daugherty ME, Shearer GR. Cholecystectomy: to drain or not to drain. J Surg Res 1978;24:259-263.
8. Goco IR, Chambers LG. Dollar and cents: mini-cholecystectomy and early discharge. South Med J 1988;81:162-163.
9. Dubois F, Icard P, Berthelot G, Levard H. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg 1990; 211: 60-62.
10. Moss C. Discharge within 24 hours of elective cholecystectomy. Arch Surg 1986;121:1.159-1.161.
11. Pareja JC, Callejas-Neto F, Leonardi LS, et al. Minilaparotomy for cholecystectomy. Braz Arch Dig Surg 1992;7:51-53.
12. Zilberstein B, Ceconello I, Ramos AC, et al. Cholecystectomy via minilaparotomy. Braz Arch Dig Surg 1992;7:54-56.
13. Perissat J. Laparoscopic cholecystectomy: The European experience. Am J Surg 1993;165:444-448.
14. Miller RD. Anesthesia. In: Way LW. Current surgical diagnosis and treatment. 10^a edição. New Jersey: Appleton & Lange, 1994, p 175.
15. Arregui ME, Davis CJ, Arkush A, et al. In selected patients outpatient laparoscopic cholecystectomy is safe and significantly reduces hospitalization charges. Surg Laparosc Endosc 1.991; 1(4):240-245.
16. Llorente J. Laparoscopic cholecystectomy in the ambulatory surgery setting. J Laparoendosc Surg 1992; 2(1):23-26.
17. Smith R, Kolyn D, Pace R. Outpatient laparoscopic cholecystectomy. HPB Surg 1994;7(4):261-264.
18. Haicken BN. Laser laparoscopic cholecystectomy in the ambulatory setting. J Post Anesth Nurs 1991;6(1):33-39.
19. Mja1and O, Buanes T, Raeder J, et al. Laparoscopic cholecystectomy as ambulatory surgery. Safety requirements, benefit potential and patient satisfaction. Tidsskr Nor Laegeforen 1995;115(18): 2.240- 2.243.
20. Tuckey JP, Morris GN, Peden CJ, et al. Feasibility of day case 1aparoscopic cholecystectomy in unselected patients. Anesthesia 1996; 51(10):965-968.
21. Oliva AL. Anestesia para pacientes de curta permanência hospitalar. R Bras Anest 1993;33:183-197.
²²
Miller RD. Anesthesia. In: White PF. Outpatient Anesthesia. Ed USA, 1990, P 2.025-2.059.
²³
White PF. Patient selection and anesthesic annual meeting of the American Society of Anesthesiologists. Annual Reflesher Course Tecture, San Francisco, 1991,512(1-7)42 st,
24. Carter JA, Dye AM, Cupper CM. Recovery from day-case anaesthesia: The effective of different inhalational anaesthetic agents. Anaesthesia 1985;40:545-548.
25. Prasad A, Foley RJ. Day case laparoscopic cholecystectomy: a safe and cost effective procedure. Eur J Surg 1996;162(1): 43-46.
26. Michaloliakou C, Chung F, Sharma S. Preoperative multimodal analgesia facilities recovery after ambulatory laparoscopic cholecystectomy. Anesth Analg 1996;82(1):44-51.
27. Taylor E, Gaw F, Kennedy C. Outpatient laparoscopic cholecystectomy feasibility. J Laparoendosc Surg 1996;6(2):73-77.
28. Voitk AJ. Outpatient cholecystectomy. J Laparoendosc Surg 1996; 6(2):79-81.
29. Fiorillo MA, Davidson PG, Fiorillo M, et al.- 149 ambulatory laparoscopic cholecystectomies. Surg Endosc 1996;10(1):52-56.

Endereço para correspondência:

Dr. Almino Cardoso Ramos

Av. Brasil, 703

01431-000 - São Paulo - SP

Datas de Publicação

Publicação nesta coleção
26 Jul 2010
Data do Fascículo
Fev 1998

Histórico

Recebido
22 Abr 1997
Aceito
15 Set 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Ferraz EM, Bacelar TS, Melo E, et al. Cholecystectomy by minilaparotomy on an outpatient basis: an analysis of 36 patients. Braz Arch Dig Surg 1992;7:47-50.

[2] 2. Miller TA. Laparoscopic cholecystectomy: passing fancy or legitimate treatment option? Gastroenterology 1990;99:1.527-1.529.

[3] 3. Orlando R 3rd, Russell JC. Managing gallbladder disease in a cost-effective manner. Surg Clin North Am 1996;76(1):117-128.

[4] 4. Langenbuch CE. Fall von extirpation der gallenblase wegen chronischer cholelitiasis. Klin Wochenschr 1882:725.

[5] 5. Goco IR, Chambers LG. Mini-cholecystectomy and operative cholangiography . A means of cost containment. Am Surg 1983; 49: 143 -145.

[6] 6. Gerber A. An appraisal of paralytic ileus and the necessity of postoperative gastrointestinal suction. Surg Gynecol ObsteI 1963; 117:294-296.

[7] 7. Maull K, Daugherty ME, Shearer GR. Cholecystectomy: to drain or not to drain. J Surg Res 1978;24:259-263.

[8] 8. Goco IR, Chambers LG. Dollar and cents: mini-cholecystectomy and early discharge. South Med J 1988;81:162-163.

[9] 9. Dubois F, Icard P, Berthelot G, Levard H. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg 1990; 211: 60-62.

[10] 10. Moss C. Discharge within 24 hours of elective cholecystectomy. Arch Surg 1986;121:1.159-1.161.

[11] 11. Pareja JC, Callejas-Neto F, Leonardi LS, et al. Minilaparotomy for cholecystectomy. Braz Arch Dig Surg 1992;7:51-53.

[12] 12. Zilberstein B, Ceconello I, Ramos AC, et al. Cholecystectomy via minilaparotomy. Braz Arch Dig Surg 1992;7:54-56.

[13] 13. Perissat J. Laparoscopic cholecystectomy: The European experience. Am J Surg 1993;165:444-448.

[14] 14. Miller RD. Anesthesia. In: Way LW. Current surgical diagnosis and treatment. 10^a edição. New Jersey: Appleton & Lange, 1994, p 175.

[15] 15. Arregui ME, Davis CJ, Arkush A, et al. In selected patients outpatient laparoscopic cholecystectomy is safe and significantly reduces hospitalization charges. Surg Laparosc Endosc 1.991; 1(4):240-245.

[16] 16. Llorente J. Laparoscopic cholecystectomy in the ambulatory surgery setting. J Laparoendosc Surg 1992; 2(1):23-26.

[17] 17. Smith R, Kolyn D, Pace R. Outpatient laparoscopic cholecystectomy. HPB Surg 1994;7(4):261-264.

[18] 18. Haicken BN. Laser laparoscopic cholecystectomy in the ambulatory setting. J Post Anesth Nurs 1991;6(1):33-39.

[19] 19. Mja1and O, Buanes T, Raeder J, et al. Laparoscopic cholecystectomy as ambulatory surgery. Safety requirements, benefit potential and patient satisfaction. Tidsskr Nor Laegeforen 1995;115(18): 2.240- 2.243.

[20] 20. Tuckey JP, Morris GN, Peden CJ, et al. Feasibility of day case 1aparoscopic cholecystectomy in unselected patients. Anesthesia 1996; 51(10):965-968.

[21] 21. Oliva AL. Anestesia para pacientes de curta permanência hospitalar. R Bras Anest 1993;33:183-197.

[22] ²²
Miller RD. Anesthesia. In: White PF. Outpatient Anesthesia. Ed USA, 1990, P 2.025-2.059.

[23] ²³
White PF. Patient selection and anesthesic annual meeting of the American Society of Anesthesiologists. Annual Reflesher Course Tecture, San Francisco, 1991,512(1-7)42 st,

[24] 24. Carter JA, Dye AM, Cupper CM. Recovery from day-case anaesthesia: The effective of different inhalational anaesthetic agents. Anaesthesia 1985;40:545-548.

[25] 25. Prasad A, Foley RJ. Day case laparoscopic cholecystectomy: a safe and cost effective procedure. Eur J Surg 1996;162(1): 43-46.

[26] 26. Michaloliakou C, Chung F, Sharma S. Preoperative multimodal analgesia facilities recovery after ambulatory laparoscopic cholecystectomy. Anesth Analg 1996;82(1):44-51.

[27] 27. Taylor E, Gaw F, Kennedy C. Outpatient laparoscopic cholecystectomy feasibility. J Laparoendosc Surg 1996;6(2):73-77.

[28] 28. Voitk AJ. Outpatient cholecystectomy. J Laparoendosc Surg 1996; 6(2):79-81.

[29] 29. Fiorillo MA, Davidson PG, Fiorillo M, et al.- 149 ambulatory laparoscopic cholecystectomies. Surg Endosc 1996;10(1):52-56.