RESUMO
PURPOSE: Single-fulcrum laparoscopic cholecystectomy (SFLC) is a variant type of single incision and multi-port technique that does not use specialized one-port devices or articulating instruments. We retrospectively compared perioperative outcomes of SFLC with those of conventional laparoscopic cholecystectomy (CLC). MATERIALS AND METHODS: Between March 2009 and December 2010, SFLC was performed in 130 patients. Among them, 105 patients with uncomplicated gallbladder disease (no inflammation or no clinical symptoms) and another 105 patients who underwent CLC were selected for this study. RESULTS: There was no open conversion. In comparison with CLC, SFLC was performed more often in young (46.4+/-12.2 years vs. 52.5+/-13.6 years, p=0.001) female patients (80/25 vs. 62/43, p=0.008). The total operation time was longer in SFLC (56.7+/-14.1 min vs. 47.5+/-17.1 min, p<0.001), but pain scores immediately after operation and at discharge time were lower for SFLC than for CLC (3.1+/-1.3 vs. 4.0+/-1.9, p<0.001, 2.0+/-0.9 vs. 2.4+/-0.8, p=0.002). Total cost was lower for SFLC than for CLC (US $ 1801+/-289.9 vs. US $ 2003+/-617.4, p=0.004). There were no differences in hospital stay or complication rates. CONCLUSION: SFLC showed greater technical feasibility and cost benefits in treating uncomplicated benign gallbladder disease than CLC.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colecistectomia Laparoscópica/economia , Doenças da Vesícula Biliar/economia , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Laparoscopic Cholecystectomy (LC) is compared to the Open and Minilap approaches in a Cost Minimization Analysis for public hospitals in Trinidad and Tobago. The analysis shows that despite the high initial equipment cost required to perform LC, substantial savings can be achieved at the hospital level by converting from a minilap or open regime to a laparoscopic regime for cholecystectomy. Because of the reduced recovery period for the patient, LC represents further savings to other sectors of the economy as patients return to work much earlier after LC than after the other two approaches
La colecistectomía laparoscópica (CL) es comparado aquí con la cirugía abierta y la mini-laparotomía en un análisis de minimización de costos para los hospitales públicos en Trinidad y Tobago. El análisis muestra que a pesar del alto costo inicial del equipo requerido para realizar la CL, pueden lograrse ahorros sustanciales a nivel de hospital mediante la conversión del régimen de minilaparotomía o el de cirugía abierta a un régimen laparoscópico en la realización de la cole-cistectomía. En virtud de la reducción del periodo de recuperación de los pacientes, la CL representa ahorros ulteriores en otros sectores de la economía, ya que los pacientes regresan a sus trabajos en un espacio de tiempo mucho más corto, en comparación con lo que ocurre con las otras dos vías de acceso.