Abstract

MANSILLA, Dick Manrique; MARQUEZ, Helard Aquino  and  GARRO MONTORO, Emilio. Laparoscopic appendectomy: an ambulatory program model. rev. colomb. cir. [online]. 2008, vol.23, n.2, pp.74-84. ISSN 2011-7582.

Objectives. To analyze results of ambulatory appendectomy performed at diverse private institutions in Lima, Perú. Analysis included postoperative morbidity, and the identification of causes of non scheduled hospital admission and readmission. Materials and methods. Retrospective, transverse and descriptive study (March 2001 to February 2006) in 79 patients scheduled for ambulatory laparoscopic appendectomy. Preoperative diagnosis was acute non-perforated appendicitis in all patients, and therefore all were managed as surgical emergency cases. All patients fulfilled the criteria established for major ambulatory surgery. Ambulatory cases were considered those patients that registered a hospital stay of less than 12 hours, short hospital stay those that remained in the hospital for 12 to 24 hours, and non scheduled hospital admission those in which hospital stay was more than 24 hours, independent of the time of surgery, day or night. Results. Median age was 34.5 ± 4.1 years (range 13 to 72 years), with predominance of the male gender (61.5%). Operating time was 46.5 ± 14 minutes (range 25 to 90 minutes). Fifty seven patients (72.2%) had a hospital stay of less than 12 hours, 15 (19%) a stay between 12 and 24 hours, and 7 (8.8%) a stay longer than 24 hours (range 24 to 48 hours). Following discharge, there were 2 readmissions in the ambulatory group, one due to intense omalgia and the other because of postoperative nausea and vomiting (1.2% readmission rate). In the short hospital stay group, the causes of hospital readmission were postoperative nausea and vomiting, 4; postoperative pain, 3; administrative reasons, 4; refusal to return to home, 2; urinary retention, 2. In the group of non scheduled hospital admission, causes were postoperative pain, 2; administrative reasons, 1, and medical observation, 4. There were no conversions to laparotomy, nor mortality. Conclusions. Laparoscopiv appendectomy is a procedure that could successfully be included in programs of ambulatory surgery in selected cases of acute appendicitis, because for its safety and low morbidity; good results depend of a adequate selection, meticulous surgical technique, short operating time, antibiotic and antiemetic prophylaxis, general anesthesia with minimal use of opiaceus agents, and a preventive multimodal analgesia scheme.

Keywords : appendicitis, appendectomy; laparoscopy; ambulatory surgical procedures.

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