Patienteneinschätzungen und Analyse der frühpostoperativen Rekonvaleszenz bei der laparoskopischen Cholezystektomie unter dem Aspekt einer ambulanten Durchführung

Laparoscopic cholecystectomy (LC) is one of the most frequently performed minimally invasive visceral-surgical operations and has established itself as a particularly standardised, safe, and stressless procedure. For many years it has been considered as a gold standard in the treatment of symptomatic cholecystolithiasis. The diminished stress related to LC is shown by countless positive effects in the patients convalescence. These benefits comprise the need of a smaller inlet into the abdominal cavity thus causing less trauma to the abdominal wall and showing better cosmetic results, considerably reduced postoperative pain, a low rate of wound healing disturbances, and a reduced hospitalisation and convalescence time thus enabling the patients a faster return to everyday- and professional life. In the health care system these positive effects of minimally invasive surgery brought a trend towards shifting some of the procedures to outpatient medical care and overnight hospitalisation. The aim of this prospective observational study was to analyse whether patients regard LC as an outpatient treatment and to monitor their convalenscence after having undergone such a procedure. For the period of one year, from 1. October 2012 to 30. September 2013, 150 patients of the ASA I and II group who underwent elective LC were included in this study. All patients were supervised post-surgically in the ward for at least 2 days. In this study, during the preoperative period, the patients willingness to undergo an outpatient treatment was evaluated. Furthermore, the course of surgery, intraoperative findings, complications, and postoperative convalescence. For this purpose the essential parameters of postoperative convalescence such as postoperative pain, feeling of nausea and vomiting as well as the time until first mobilisation and oral absorption of food and liquids were analysed. Additionally, the patients were asked for their own point of view regarding their discharge from hospital by taking into consideration their general impression of the treatment and their postsurgical condition. This study could prove low stress related to LC and fast postoperative convalescence. However, the immediate postsurgical concomitants can be very stressful for patients. With regard to an outpatient treatment pain and postoperative fatigue turned out to be the substantially limiting factors. During the study period it could be observed that only 20% of the patients would give their consent to an outpatient LC. Nevertheless, 74% of the patients felt being able to be discharged from hospital in the course of the first day after surgery. In the case of an elective LC the present study shows that reducing the hospital time to overnight hospitalisation is possible and even desired by patients. Outpatient LC, however, even if it is medically acceptable in many cases, should be offered only those patients who wish to be treated this way and who fulfill the strict selection criteria.