Nicola de'Angelis1, Benjamin Menahem2,3, Philippe Compagnon1, Jean Claude Merle4, Francesco Brunetti1, Alain Luciani5,6, Daniel Cherqui7, Alexis Laurent8,9. 1. Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est-UPEC, Address: 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. 2. UMR INSERM U1086 Cancers et Prevention, Centre François Baclesse, Avenue du Général Harris, 14045, Caen Cedex, France. 3. UFR de Médecine, 2 rue des Rochambelles, 14033, Caen Cedex, France. 4. Department of Anesthesiology, Henri Mondor Hospital, AP-HP, Créteil, France. 5. Department of Radiology, Henri Mondor Hospital, AP-HP, Créteil, France. 6. INSERM U955, Team 18, Institut Mondor de Recherche Biomédicale, Créteil, France. 7. Hepatobiliary and Pancreatic Surgery and Liver Transplantation Unit, Paul Brousse Hospital, Paris, France. 8. Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est-UPEC, Address: 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. alexis.laurent@hmn.aphp.fr. 9. INSERM U955, Team 18, Institut Mondor de Recherche Biomédicale, Créteil, France. alexis.laurent@hmn.aphp.fr.
Abstract
BACKGROUND: Technical advances in laparoscopy and enhanced recovery after surgery programs have progressively decreased the need for hospitalization. The present study aimed to explore the feasibility and safety of an early discharge protocol after minor laparoscopic liver resection (LLR). METHODS: The study sample consisted of patients with both benign and malignant hepatic lesions involving no more than two hepatic segments who underwent minor LLR and were discharged within 24 h. Patients were selected based on their fitness for surgery, proximity to the hospital, and availability of a responsible adult to care for them once discharged. Patients and their accompanying caregiver were instructed about the procedure, its potential complications, and the conditions required for an early discharge. They were also provided with a 24-h dedicated phone number for assistance. RESULTS: Twenty-four patients [mean age 48.9 year (SD 14.75); 12 women] with no more than one comorbidity were included. The majority (87.5%) was classified as ASA I or II. Thirteen patients (46%) were operated on for malignant lesions. The median operative time was 90 min, the median pneumoperitoneum time was 60 min, and the estimated blood loss was 50 mL. Mortality was zero. No transfusion, conversion, or pedicule clamping was necessary. No anesthesia-related complications occurred. All patients were discharged at 24 h. Only one patient (4.2%) was readmitted at postoperative day 3 for intolerable abdominal pain due to a wound abscess that was treated by antibiotics. CONCLUSION: By applying a standardized protocol for admission, preoperative workup, and anesthesia, early discharge after minor LLR can be successfully carried out in highly selected patients with minimal impact on primary healthcare services.
BACKGROUND: Technical advances in laparoscopy and enhanced recovery after surgery programs have progressively decreased the need for hospitalization. The present study aimed to explore the feasibility and safety of an early discharge protocol after minor laparoscopic liver resection (LLR). METHODS: The study sample consisted of patients with both benign and malignant hepatic lesions involving no more than two hepatic segments who underwent minor LLR and were discharged within 24 h. Patients were selected based on their fitness for surgery, proximity to the hospital, and availability of a responsible adult to care for them once discharged. Patients and their accompanying caregiver were instructed about the procedure, its potential complications, and the conditions required for an early discharge. They were also provided with a 24-h dedicated phone number for assistance. RESULTS: Twenty-four patients [mean age 48.9 year (SD 14.75); 12 women] with no more than one comorbidity were included. The majority (87.5%) was classified as ASA I or II. Thirteen patients (46%) were operated on for malignant lesions. The median operative time was 90 min, the median pneumoperitoneum time was 60 min, and the estimated blood loss was 50 mL. Mortality was zero. No transfusion, conversion, or pedicule clamping was necessary. No anesthesia-related complications occurred. All patients were discharged at 24 h. Only one patient (4.2%) was readmitted at postoperative day 3 for intolerable abdominal pain due to a wound abscess that was treated by antibiotics. CONCLUSION: By applying a standardized protocol for admission, preoperative workup, and anesthesia, early discharge after minor LLR can be successfully carried out in highly selected patients with minimal impact on primary healthcare services.
Authors: Brian K P Goh; Chung-Yip Chan; Jen-San Wong; Ser-Yee Lee; Victor T W Lee; Peng-Chung Cheow; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung Journal: Surg Endosc Date: 2014-11-27 Impact factor: 4.584