Transcylindrical cholecystectomy under local anesthesia plus sedation. A pilot study

Abstract

Background and study aim: The practice of laparoscopic cholecystectomy under local anesthesia is almost anecdotal. For 15 years we have been using a "transcylindrical cholecystectomy" technique for the treatment of cholelithiasis, cholecystitis, and choledocholithiasis. The present study was undertaken to assess the feasibility of transcylindrical cholecystectomy under local anesthesia through a prospective and longitudinal efficacy study.

Patients and methods: Transcylindrical cholecystectomy is performed gas-free through a single cylinder 3.8 cm in diameter and 10.0 cm in length. In 60 patients suffering from cholelithiasis (mean age 52.6 years, range 31-83 years; men/women 13/47; body mass index 29.6 kg/m(2), range 24-44 kg/m(2)), transcylindrical cholecystectomy was planned and started under local anesthesia. Patients were reviewed 5 days after surgery; pain was assessed using a visual analog scale (VAS) and procedure satisfaction was assessed following completion of a patient questionnaire.

Results: Surgery was satisfactorily completed through the cylinder in all patients. In 13 patients (21.7 %) local anesthesia was converted to general anesthesia due to technical difficulties in 11 patients (two related to patient body volume), respiratory depression in one patient, and poor patient tolerance in one patient. Postoperative complications were: wound infection (n = 1, 1.7 %), wound seromas (n = 2, 3.3 %), and nausea (n = 3, 5 %). After surgery, only three patients experienced pain at rest with VAS values of 0.5, 1.5, and 2.9, respectively. All but two patients were discharged from hospital on the day of surgery, and all patients were satisfied with the procedure.

Conclusions: Transcylindrical cholecystectomy under local anesthesia is a feasible technique that builds on the benefits of laparoscopic cholecystectomy, and confers an economic advantage and improved safety for patients.