Early recognition of cholecystectomised patients with complication – feasible or not?

Vladimir Zivanovic, MD, MSc, Radisav Scepanovic, MD, Prof, PhD, Radoslav Perunovic, MD, PhD, Goran Vasic, MD

KBC Dr D.Misovic University hospital

In our institution for 15 years was practice that we perform laparoscopic surgery as 48h procedure. First day admission with repeating of necessary laboratory findings and preoperative consultation with anesthesiologist and second day we perform laparoscopic cholecystectomy and on the third day in the morning we release patient. After reorganization and cutting number of beds from 110 to 15, we start doing these procedures as 24h surgery. We push all necessary preparation as ambulatory procedures including consultation with anesthesiologist, changing oral anticoagulant therapy to low molecular heparins and all other preoperative activities.
We are accepting first patients to the hospital 60 min before the actual operation. In these circumstances we need thorough objective following of the patient and its postoperative status using night’s clinics of doctor who perform operation and morning after operation control blood test – serum bilirubin level and control US examination.
In our institution we perform from 2010 till September 2012, 2.680 laparoscopic cholecystectomies as elective 24h surgical procedures. Those procedures perform 6 experienced surgeons and 4 young colleges. Mean blood level of bilirubin is 60% elevated in comparison to preoperative values and around 70% of patients have some collection with localization at level of gall bladder bad. During this period we have 8 patient with bleeding in need for reoperation and 7 patients with bile leakage. There were no other patients discharged on postoperative day one that afterword’s was recognized as patient with complication.
In conclusion we can say that transition from 48h to24h surgery did not changed in number of neither complication nor raising the percentage of unrecognized postoperative complication. Using this set of postoperative diagnostic and clinical evaluation from involved surgeon was satisfactory for early recognition of cholecystectomised patients with complication.

Session: Poster Presentation

Program Number: P623