Donald E. Wenner, MD, FACS
General Surgery
Abstract
This study was undertaken to examine our experience with laparoscopic cholecystectomy at a free standing ambulatory surgery center. A retrospective review of all laparoscopic cholecystectomies performed at the ambulatory center over a four year period was undertaken. All surgeons operating at the ambulatory center were experienced with out-patient laparoscopic cholecystectomy in a hospital setting. All surgeons perform routine dynamic fluoroscopic intraoperative cholangiography. All operations were of a non-emergent nature for cholelithiasis or biliary colic. No Medicare patients were included as Medicare regulations preclude cholecystectomy in free standing ambulatory surgery centers. Data on rates of hospital admission, conversion to open surgery, bile duct injury, bile leaks, and incidence of choledocholithiasis is sought. The success rate for dynamic fluoroscopic intraoperative cholangiography is computed, and our experience with out-patient laparoscopic common bile duct exploration is reviewed. A total of 342 laparoscopic cholecystectomies were performed in this four year period. Two patients (0.65%) required hospital admission. There was a 0% rate of conversion to open surgery. The rate of bile duct injury and postoperative bile leak was also 0%. Dynamic fluoroscopic intraoperative cholangiography was successfully performed in 90% of these patients. Choledocholithiasis was encountered in four patients (1.12%) and was managed using laparoscopic common bile duct exploration techniques. Laparoscopic cholecystectomy is a safe procedure in the free standing ambulatory surgery environment. Very low complication rates are attainable. Bile duct stones are infrequently encountered and can be managed using laparoscopic techniques in the ambulatory setting.