Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2010, vol. 19, nr 2, March-April, p. 227–232

Publication type: original article

Language: English

One-Day Surgery and Fast-Track Principles

Program działań optymalizujących opiekę okołooperacyjną i jego zastosowanie w chirurgii jednego dnia

Pavel Zonča1,, Jerzy Rudnicki2,, Adam Góralczyk3,, Dariusz Houdail2,, Jakub Wachnik2,, Renata Thoma-Jancewicz2,

1 Zentrum für Minimal-Invasive Chirurgie, Allgemeinchirurgie, Viszeralchirurgie und Unfallchirurgie, Wesseling, Germany

2 Department of Minimally Invasive Surgery and Proctology, Wroclaw Medical University, Poland

3 Lagan Valley Hospital, Antrim, Ireland

Abstract

Objectives. The aim of the study was to show the current view on fast-track programs optimizing perioperative care and its application in one-day surgery. The authors show the possibilities of fast-track principles in all surgical fields.
Material and Methods. Fast-track principles identified and confirmed in trials were applied in one-day surgery. Ninety patients (39 men and 51 women, average age: 52.4 years) who underwent elective laparoscopic cholecystectomy as a planned one-day procedure were involved in the study.
Results. Elective laparoscopic cholecystectomy was performed in 89 patients without operative or postoperative complications. Eighty-two patients were discharged on the same day the surgery was performed. Drainage was used in 6 patients. These patients were discharged on the first postoperative day. One patient underwent open cholecystectomy as a conversion of laparoscopic cholecystectomy because of difficult anatomical findings with firm adhesions. This patient was discharged on the fourth postoperative day. No postoperative complications were observed in any patient. No patient required readmission.
Conclusion. The authors focused on adequate treatment of postoperative pain, early mobilization, and early introduction of oral nutrition. Other principles of the enhanced recovery program were applied as well. The fast-track approach optimizes perioperative care and allows its application in both minimally invasive and traditional major surgery. It is considered a safe method according to current literature.

Streszczenie

Cel pracy. Przedstawienie aktualnych poglądów na program działań („szybka ścieżka”) optymalizujących opiekę okołooperacyjną i jego zastosowanie w chirurgii jednego dnia. Autorzy badania wskazują na możliwości zastosowania tej procedury we wszystkich dziedzinach chirurgii.
Materiał i metody. Zasady programu zostały wytyczone i potwierdzone na podstawie badań prowadzonych na bazie „chirurgii jednego dnia”. 90 pacjentów zakwalifikowanych do badania zostało poddanych elektywnej laparoskopowej cholecystektomii jako planowemu jednodniowemu zabiegowi chirurgicznemu. Badaną grupę stanowiło 39 mężczyzn i 51 kobiet w średnim wieku – 52,4 lat.
Wyniki. Elektywną laparoskopową cholecystektomię wykonano u 89 pacjentów. 82 pacjentów zostało wypisanych z oddziału w dniu wykonania zabiegu. 6 operowanych wymagało drenażu jamy otrzewnowej. Otwartą cholecystektomię jako konwersję metody laparoskopowej wykonano u 1 pacjenta z powodu licznych zrostów powodujących trudności operacyjne. Pacjent ten został wypisany z oddziału w 4. dobie po zabiegu. Nie zaobserwowano powikłań śródi pooperacyjnych u żadnego z obserwowanych pacjentów.
Wnioski. Autorzy badania podkreślają potrzebę odpowiedniego leczenia bólu pooperacyjnego, wczesnej mobilizacji pacjenta oraz wczesnego wdrażania żywienia doustnego. „Szybka ścieżka” opieki okołooperacyjnej optymalizuje i standaryzuje opiekę okołooperacyjną i pozwala na jej zastosowanie zarówno w chirurgii małoinwazyjnej, jak i w tradycyjnych dużych zabiegach chirurgicznych. Jest bezpieczną metodą opartą na najnowszych doniesieniach z literatury światowej.

Key words

one-day surgery, fast-track, perioperative care, elective laparoscopic cholecystectomy

Słowa kluczowe

chirurgia jednego dnia, „szybka ścieżka”, opieka okołooperacyjna, elektywna laparoskopowa cholecystektomia

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