Acute and Chronic Calculose Cholecystitis As One Day Surgery Treatment

Vladimir Zivanovic, MsC MD, Goran Vasic, MD, Radoslav Perunovic, PhD MD, Predrag Stevanovic, PhD MD, Radisav Scepanovic, PhD MD. KBC Dr D.Misovic University hospital

Laparoscopic cholecystectomie as one day procedure, we start in December 2009 and we perform 1805 operations until the end of September 2011. Out of 1805 cholecystectomies 172 was performed for acute inflamation. All patient was released next day after control US examination and blood sample for bilirubin, so thay spent less than 24 hour in hospital bed. Oldest patient was 81 year old.
At the department of surgery “Dr D. Mišovic” hospital in Belgrade, After a fire in our surgical department with 120 bads we have to close department. After a month we rearenge in near by bilding with urology department 6 bads for laparoscopic one day surgery. We have to rearenge ambulatory preparing of patients sutiable for one day surgery. We do all necessary preparation including prehospital bowel preparation and DVT prophylaxis, so patient came to hospital only one hour before the operation.
Cholecystectomie performed as emergency procedures was organised through emergency department. After examination of the patient with US and neccesary laboratory test with decision for emediate surgery and anesteziology consultation for fitting the one day surgery, patient was taken to the OR and performed emergency surgery for acute cholecystitis. After thorough rinsing of abdominal cavity et the end of procedure and one protective shot of antibiotic other outcome is same as in elective surgery. We use drainage tube in one case and their removal was next day before discharge from hospital.
Using ultrasound hook and water dissection reveal itself as an adequate tool. In same manner ultrasound dissection shorten operation time because we can dissect tissue without losing time on changing instrument. In conclusion we can advocate one day surgery in patients with acute and chronic cholecystitis.
 

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