Implementation of Ambulatory Laparoscopic Cholecystectomy on Patients in Suegical Waiting List for Gallstones

One of the biggest problems about public sanitary systems are Surgical Waiting Lists (SWL). Getting an appropriate balance between an acceptable time on SWL and sanitary costs relies on multiple variables. Laparoscopic cholecystectomy on ambulatory basis (LCA), may result in a better use of resources without an impact on assistance quality. Nevertheless, this is not a widespread procedure on Spanish surgical services. Our objective is to determine the theoretical applicability of LCA within patients included in SWL in a level II hospital prior carrying out a LCA program. Methods: Observational study. Exclusion criteria for LCA are: >65 years old, ASA>II, acute cholecystitis, acute pancreatitis or previous ERCP, living >50 km from hospital, impossibility to undergo laparoscopic surgery or the need to undergo more tan one surgery at a time. Results: There are 242 patients on SWL for LCA. 156 are women. Median age is 57,36. The main cause of exclusion is > 65 years old (31% from all patients), followed by distance home-hospital >50km (15.7%), previous acute cholecystitis (14.05%) or biliary pancreatitis (7%), anesthesic risk (ASA III) (11.16%), ERCP prior to surgery (11.16%), and the need to perform another surgery on the same act (0.83%). Patients candidate for LCA are 124, which entails that the 51.24% of patients on SWL for cholecystectomy are potentially aspirant for LCA. Conclusion: Potential LCA in our hospital is 51,24%, which may result on an important decreasing of hospital admissions without detriment on theoretical surgical results. In our series, main limiting factor is age that reflects characteristics of our Department population.