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Minor laparoscopic liver resection: toward 1-day surgery?

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Abstract

Background

Technical advances in laparoscopy and enhanced recovery after surgery programs have progressively decreased the need for hospitalization. The present study aimed to explore the feasibility and safety of an early discharge protocol after minor laparoscopic liver resection (LLR).

Methods

The study sample consisted of patients with both benign and malignant hepatic lesions involving no more than two hepatic segments who underwent minor LLR and were discharged within 24 h. Patients were selected based on their fitness for surgery, proximity to the hospital, and availability of a responsible adult to care for them once discharged. Patients and their accompanying caregiver were instructed about the procedure, its potential complications, and the conditions required for an early discharge. They were also provided with a 24-h dedicated phone number for assistance.

Results

Twenty-four patients [mean age 48.9 year (SD 14.75); 12 women] with no more than one comorbidity were included. The majority (87.5%) was classified as ASA I or II. Thirteen patients (46%) were operated on for malignant lesions. The median operative time was 90 min, the median pneumoperitoneum time was 60 min, and the estimated blood loss was 50 mL. Mortality was zero. No transfusion, conversion, or pedicule clamping was necessary. No anesthesia-related complications occurred. All patients were discharged at 24 h. Only one patient (4.2%) was readmitted at postoperative day 3 for intolerable abdominal pain due to a wound abscess that was treated by antibiotics.

Conclusion

By applying a standardized protocol for admission, preoperative workup, and anesthesia, early discharge after minor LLR can be successfully carried out in highly selected patients with minimal impact on primary healthcare services.

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Author information

Authors and Affiliations

  1. Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est—UPEC, Address: 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France

    Nicola de’Angelis, Philippe Compagnon, Francesco Brunetti & Alexis Laurent

  2. UMR INSERM U1086 Cancers et Prevention, Centre François Baclesse, Avenue du Général Harris, 14045, Caen Cedex, France

    Benjamin Menahem

  3. UFR de Médecine, 2 rue des Rochambelles, 14033, Caen Cedex, France

    Benjamin Menahem

  4. Department of Anesthesiology, Henri Mondor Hospital, AP-HP, Créteil, France

    Jean Claude Merle

  5. Department of Radiology, Henri Mondor Hospital, AP-HP, Créteil, France

    Alain Luciani

  6. INSERM U955, Team 18, Institut Mondor de Recherche Biomédicale, Créteil, France

    Alain Luciani & Alexis Laurent

  7. Hepatobiliary and Pancreatic Surgery and Liver Transplantation Unit, Paul Brousse Hospital, Paris, France

    Daniel Cherqui

Authors
  1. Nicola de’Angelis
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  2. Benjamin Menahem
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  3. Philippe Compagnon
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  4. Jean Claude Merle
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  5. Francesco Brunetti
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Correspondence to Alexis Laurent.

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Disclosure

Nicola de’Angelis, Benjamin Menahem, Jean Claude Merle, Francesco Brunetti, Philippe Compagnon, Alain Luciani, Daniel Cherqui, and Alexis Laurent have no conflicts of interest or financial ties to disclose.

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de’Angelis, N., Menahem, B., Compagnon, P. et al. Minor laparoscopic liver resection: toward 1-day surgery?. Surg Endosc 31, 4458–4465 (2017). https://doi.org/10.1007/s00464-017-5498-9

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  • DOI: https://doi.org/10.1007/s00464-017-5498-9

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