Laparoscopic day-case liver surgery (without overnight hospitalization) is safe and feasible for selected patients and selected indications

Abstract

Introduction: Day-case surgery has boomed over years, as has laparoscopic liver surgery. The aim of this study was to show the feasibility and safety of day-case laparoscopic liver surgery. Materials and Methods: This was a prospective, descriptive, unicentric, non-randomized study, including all patients undergoing laparoscopic minor resection, radiofrequency ablation or cysts fenestration, from july 2015 to june 2018. Exclusions criterias were major resection, laparotomy, procedure-related criterias (lesions considered difficult to access), patient-related criterias (decompensate cirrhosis or with portal hypertension, BMI to 45kg/m2), patient's refusal, and contraindication to day-case surgery. Primary study endpoint was succes of day-case management. Secondary endpoints were compliance to protocol, length of stay (LOS) in case of hospitalization and complication rate. A comparison between ambulatory population with excluded populations procedure-related criterias and patient-related criterias was also realised. Results: During the study period, 231 patients have undergone liver surgery, with 37 patients (16.0%) on day-case surgery for minor resection (23 patients, including 1 left lobectomy), radiofrequency ablation (5 patients), combined resection and ablation procedure (1 patient), and cysts fenestration (8 patients). Among them, 26 patients (70.3%) were a succes of day-case management. Protocol compliance was respected for 21 patients (56.8%): there were 11 unplanned admissions (29.7%), 3 unplanned consultations (8.1%) and 4 unplanned hospitalizations (10.8%). Median LOS was 1 day in case of unplanned admission, 1.5 days in case of unplanned hospitalization. Complication rate was 5.4% and reoperation rate was 2.8%. Complication rate was significatively lower in the ambulatory group than in the group of exclusions for procedure-related criterias. Rehospitalization rate was higher in ambulatory group than in the groups of exclusions for procedure-related criterias and exclusions for patient's refusal. There were no significant differences concerning mortality rate and reoperation rate. Conclusion: Day-case laparoscopic liver surgery is feasible and safe for selected patients and selected indications.