Expert consensus on day-case laparoscopic cholecystectomy / 临床肝胆病杂志

‍The concept of day-case surgery was first proposed by British surgeon Nicoll， referring to the surgery or procedure in which a patient completes admission and discharge within one day （24 h）. In recent years， China has gradually implemented the day-case mode of laparoscopic cholecystectomy. Day-case laparoscopic cholecystectomy could significantly shorten hospital stay， reduce hospital infections， accelerate patient recovery， improve the efficiency of medical resource utilization， and reduce medical costs. In order to provide reference for exploring and developing standardized day-case laparoscopic cholecystectomy and promote the standardized application and promotion of day-case laparoscopic cholecystectomy， the Minimally Invasive Surgery Committee of the Chinese Research Hospital Association organized experts from surgery， anesthesia， and nursing to develop this expert consensus.

Day-case Laparoscopic Cholecystectomy Without Overnight Hospitalization：Experience of 78 Cases / 中国微创外科杂志

Objective To explore the feasibility and safety of day surgery laparoscopic cholecystectomy . Methods From January 2015 to June 2015, 78 cases of day-case laparoscopic cholecystectomy were performed in our hospital .The clinical data were retrospectively reviewed .These patients were diagnosed as having cholelithiasis or cholecystic poypus .They had no severe heart or lung diseases, no history of epigastric operation , and agreed to accept day-case laparoscopic cholecystectomy without overnight hospitalization. Results Of the 78 patients, 74 patients (94.9%) successfully accepted the surgery and were discharged no more than 4 h after surgery, including 2 patients with combined laparoscopic transcyctic common bile duct exploration ( LTCBDE).The remaining 4 patients (5.1%) were admitted for overnight hospital stay , including 1 patient (1.3%) with Mirizzi syndrome type Ⅰwho was given abdominal drainage , 2 patients (2.6%) with severe nausea and vomit , 1 patient (1.3%) with airway obstruction after operation.All the 4 patients were discharged within 24 h after the surgery.The operating time was 35-152 min (mean, 80.0 ±19.7 min).The hospitalization expenses was 5688-9768 yuan (mean, 8318.0 ±848.5 yuan).The hospitalization time was 5.6-23.9 h (median, 7.4 h).Postoperative follow-up at the day of surgery, the first and the seventh postoperative day showed that none of the patients suffered from severe complications . Conclusion Day-case laparoscopic cholecystectomy is safe and feasible , on the basis of strictly selected patients , experienced surgeons , and close cooperation with anesthetists and nurses .

Anal fistula surgery in an outpatient setting: the Dubai experience / Cirurgia de fístula anal em regime ambulatorial: a experiência Dubai

AIM: To determine whether surgery for transsphincteric and complex fistula-in-ano can be performed safely as a day case. METHOD: This is a retrospective study of 66 patients with transsphincteric and complex anal fistulas, initially managed with preliminary loose Seton followed by fistulectomy and sphincter repair 2-4 months later between March 2011 and March 2014. Patients were seen at the clinic 1 week, 3 months and 1 year post-operatively and were observed for complications and recurrences; incontinence was noted down and was graded according to the Cleveland Clinic score. RESULT: Twenty-five patients (38%) had high or complex fistulas and 32 (48.5%) had a history of previous surgery. All cases were done in an outpatient setting. The Seton was kept in situ for 2-5 months (2.6 months) followed by fistulectomy and sphincter repair. Complete healing was achieved within approximately 3.6 weeks (2-8 weeks). Fifty-one patients were followed up successfully for one year. Two patients had temporary flatus incontinence which had resolved over 2-3 months. Recurrence had occurred in 2 (3.9%) patients. CONCLUSION: Transsphincteric and complex fistulas can safely be operated on as day case surgeries with high patient satisfaction and less complication in the population we studied. (AU)

OBJETIVO: Determinar se cirurgias para fístulas transesfincterianas e para fistulae in ano complexas podem ser realizadas com segurança em ambiente ambulatorial, sem pernoite do paciente no hospital. MÉTODO: Trata-se de um estudo retrospectivo de 66 pacientes com fístulas transesfincterianas e fístulas anais complexas, inicialmente tratados preliminarmente com seton de drenagem, seguido por fistulectomia e reparo do esfíncter 2-4 meses mais tarde, entre março de 2011 e março de 2014. Os pacientes foram reexaminados no ambulatório uma semana, três meses e ano após a cirurgia, tendo sido observados para complicações e recorrências; casos de incontinência foram anotados e classificados de acordo com o escore da Cleveland Clinic. RESULTADO: Vinte e cinco pacientes (38%) apresentaram fístulas altas ou complexas e 32 (48,5%) tinham história de cirurgia prévia. Todos os casos foram tratados em ambiente ambulatorial. O seton foi mantido in situ durante 2-5 meses (2,6 meses), seguido por fistulectomia e reparo do esfíncter. A cura completa se concretizou em cerca de 3,6 semanas (2-8 semanas). Cinquenta e um pacientes foram acompanhados com sucesso ao longo de um ano. Dois pacientes tiveram incontinência temporária para gases, resolvida ao longo de 2-3 meses. Recorrência ocorreu em 2 (3,9%) pacientes. CONCLUSÃO: Fístulas transesfincterianas e fístulas complexas podem ser operadas com segurança como casos ambulatoriais, sem permanência hospitalar noturna, com grande satisfação do paciente e menos complicações na população estudada. (AU)

Lichtenstein tension-free herniorrhaphy: a retrospective analysis in 4011 cases / 国际外科学杂志

ObjectiveTo evaluate results of the Lichtenstein tension-free mesh repair and summaraize the clinical experience in the treatment of the inguinal hernia. MethodsIn this retrospective study, 4011 tension-free inguinal hernia repairs were performed in 3631 patients, using a polypropylene mesh (Lichtenstein technique). Results The average hospitalization was 3.8 days, the overall complication rate was 2.4％, the recurrence rate was 0.1％. ConclusionThe Lichtenstein repair for the treatment of inguinal hernia has the advantage of less postoperative pain and low recurrence and is highly suitable for day case surgery.

Effects of Metoclopramide and Ranitidine on Preoperative Gastric Contents in Day-Case Surgery

This prospective, randomized, double-blinded study was performed to evaluate the effects of intravenous metoclopramide and ranitidine on preoperative gastric contents in outpatients receiving intravenous anesthesia for laparoscopic gynecologic surgery. Fifteen minutes before the induction of anesthesia, the Z-M group (n=20) received 50mg ranitidine and 10mg metoclopramide intravenously and the control group (n=20) received the same volume of normal saline. Before the surgery, a 14-F multiorifice nasogastric tube was inserted to aspirate the gastric contents of patients under sedation with propofol and midazolam. The mean pH values of the gastric fluid were 2.7+/-2.0 (SD) [median 1.6 (range: 1.2-7.2)] in the control group, and 6.1+/-1.9 [median 6.8 (range 1.4-7.8)] in the Z-M group. The mean aspirated volumes (mL) were 15.3+/-10.4 (SD) [median 11.0 (range: 5.0-44.0)] in the control group, and 6.9+/-10.0 (SD) [median 4.5 (range: 0-38.0)] in the Z-M group. There were significantly more high-risk (gastric fluid volumes > 25mL and pH < 2.5) patients in the control group (4/20, 20%) than in the Z-M group (1/20, 5%). In conclusion, intravenous prophylactic ranitidine and metoclopramide may be an easy and useful method to decrease the volume while increasing the pH of gastric contents, and therefore may reduce the number of patients at risk for aspiration pneumonitis in ambulatory laparoscopic procedures who receive an anesthesia.

Effects of Metoclopramide and Ranitidine on Preoperative Gastric Contents in Day-Case Surgery

This prospective, randomized, double-blinded study was performed to evaluate the effects of intravenous metoclopramide and ranitidine on preoperative gastric contents in outpatients receiving intravenous anesthesia for laparoscopic gynecologic surgery. Fifteen minutes before the induction of anesthesia, the Z-M group (n=20) received 50mg ranitidine and 10mg metoclopramide intravenously and the control group (n=20) received the same volume of normal saline. Before the surgery, a 14-F multiorifice nasogastric tube was inserted to aspirate the gastric contents of patients under sedation with propofol and midazolam. The mean pH values of the gastric fluid were 2.7+/-2.0 (SD) [median 1.6 (range: 1.2-7.2)] in the control group, and 6.1+/-1.9 [median 6.8 (range 1.4-7.8)] in the Z-M group. The mean aspirated volumes (mL) were 15.3+/-10.4 (SD) [median 11.0 (range: 5.0-44.0)] in the control group, and 6.9+/-10.0 (SD) [median 4.5 (range: 0-38.0)] in the Z-M group. There were significantly more high-risk (gastric fluid volumes > 25mL and pH < 2.5) patients in the control group (4/20, 20%) than in the Z-M group (1/20, 5%). In conclusion, intravenous prophylactic ranitidine and metoclopramide may be an easy and useful method to decrease the volume while increasing the pH of gastric contents, and therefore may reduce the number of patients at risk for aspiration pneumonitis in ambulatory laparoscopic procedures who receive an anesthesia.