Laparoscopic cholecystectomy and outpatient surgery.

of surgery has taken place with laparoscopic surgery in the late 1980s. Indeed, the linking of technologic development circumstances to the will of a number of surgeons to offer less damaging surgery led to the notion of “minimally aggressive surgery”, in which laparoscopic surgery is paradigmatic. Laparoscopic surgery entailed a number of nowadays universally accepted benefits for patients. In fact, initial distrust regarding this way of surgery has led to a careful analysis of its results which we are convinced was unparalleled before for surgical techniques. Thus, not only has laparoscopy advanced in itself, but traditional techniques have also benefited from greater rigor in outcome studies, and healthy competition has shown up regarding “lesser invasion” with increasingly small incisions, and shorter stays and postoperative periods, all of which represents great value for patients. Regarding laparoscopic cholecystectomy (LC), this procedure evolved in 6 years –from the time is was first used back in 1987– to become the gold-standard in the treatment of symptomatic cholethiasis. However, it should be noted that scientific evidence supporting its superiority versus traditional cholecystectomy as based upon controlled randomized studies is pretty scant, regardless its wide acceptance by the health-care community and patients as well. Although many comparative studies exist on all sorts of partial aspects that clearly reveal the benefits of LC –from classic morbidity and mortality, and hospital stay studies to sophisticated studies on– say –post-procedural immune response– only two prospective, randomized, single-blind studies compared laparoscopic versus open cholescystectomy (1,2), and none showed clearly significant differences for either procedure. The importance of these studies is relative when compared to downpouring experience pointing that laparoscopy provides a far more benign immediate postoperative time. We should not be oblivious regarding the fact that the so-called “surgeon factor” may never be blind –and is difficult to assess– and therefore double-blind studies are not feasible. This evidence regarding a generally benign postoperative period led to consider that this technique could be performed on an outpatient basis with no overnight hospital stay, in a search for cost savings, either institutional or private, in each procedure. We would like to stop here at any rate to superficially analyze concept differences amongst cultures and health-care models with respect to major outpatient surgery (MOS). The North American model mainly attempts to reduce costs per procedure, which in financial terms will indirectly impact on users as regards medical insurance costs and of course by making private procedures cheaper. To this end hospitals Laparoscopic cholecystectomy and outpatient surgery 1130-0108/2004/96/7/435-441 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS Copyright © 2004 ARÁN EDICIONES, S. L. REV ESP ENFERM DIG (Madrid) Vol. 96, N.° 7, pp. 435-441, 2004