Small-incision cholecystectomy (through a cylinder retractor) under local anaesthesia and sedation: a prospective observational study of five hundred consecutive cases
Transcylindrical cholecystectomy (TC) can be performed under local anaesthesia and sedation (LAS) in ambulatory surgery (AS). The aim of this study was to assess the feasibility and results of TC under LAS.
TC under LAS was proposed to 583 consecutive patients with cholelithiasis in an AS unit. For the TC procedure, a cylindrical retractor with a transparent plunger was inserted into the hepatocystic triangle, and cholecystectomy was performed through the retractor with reusable open instruments. Pre-, intra-, and post-operative variables were prospectively registered, including complications, reasons for conversion to general anaesthesia (GA), non-programmed admissions, readmissions, pain assessments, and satisfaction with the procedure.
Five hundred patients were eligible for LAS, with GA being required in 128 (25.6%) of them. AS was programmed for 447 patients. The rates of non-programmed admissions, readmissions, and conversion to laparotomy were 8.7% (39), 0.8% (4), and 2.6% (13), respectively. There was no main bile duct injury. At 24 h, physical status was good or excellent in 80.4% of the patients. A history of acute cholecystitis, male sex, a body mass index (BMI) ≥ 39.5 kg/m2, and non-suspected acute cholecystitis were found to be independent variables associated with conversion to GA.
TC under LAS is a safe procedure in AS and is feasible in 74% of cholelithiasis patients. Male sex, BMI, gallbladder wall thickness, and a history of acute cholecystitis are factors that increase the probability of conversion to GA.
This prospective study was approved by the ethics committee of Badajoz for patient protection for biomedical research and has been retrospectively registered under the research registry UIN: researchregistry3979.
KeywordsTranscylindrical cholecystectomy Local anaesthesia Ambulatory surgery
Our sincerest thanks to the Admission Service staff of the Siberia-Serena Hospital, especially to Dr. Felix Miranda, Ms. Guadalupe Díaz and Ines Parralejo, and Francisco Ballesteros Reina. Thanks are also given to Mr. Carlos J. Grau-Polo, Juan Diego Blanco, and Daragh W. Kennedy for their aid in the preparation of this manuscript, and a particular consideration to Dr. Juan Manuel Nogales for his help with the statistics section. The work is supported by the public service “Servicio Extremeño de Salud” (Extremadure Health Service)
Authorship E.J. G-T and J.J. M-M study conception and design and analysis and interpretation of data; R. G-R, J.F. S, C.D. I, P.G. M-C, M. A-J, and C. J-C Study conception and design; J.M. A-G analysis and interpretation of data; and J. A-D critical revision of the manuscript.
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