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Colecistectomia laparoscópica em regime ambulatorial Laparoscopic cholecystectomy in the outpatient on ambulatory setting

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

Abstract

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.<br>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

Topics: Colecistectomia laparoscópica, Laparoscopia, Cirurgia ambulatorial, Tempo de internação, Laparoscopic cholecystectomy, Laparoscopy, Ambulatory surgery, Length of stay, LCC:Surgery, LCC:RD1-811, LCC:Medicine, LCC:R, DOAJ:Surgery, DOAJ:Medicine (General), DOAJ:Health Sciences
Publisher: Colégio Brasileiro de Cirurgiões
Year: 1998
DOI identifier: 10.1590/S0100-69911998000100003
OAI identifier: oai:doaj.org/article:e31aa7f85bf9457fb2c05bbbf11fd24f
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