title: Laparoscopic cholecystectomy and management of biliary tract stones in a freestanding ambulatory surgery center.
abstract: OBJECTIVE
  We conducted a retrospective 4-year study of patients undergoing laparoscopic cholecystectomy at a freestanding ambulatory surgery center. Data on rates of hospital admission, conversion to open surgery, bile duct injury, postoperative bile leakage, and incidence of choledocholithiasis were analyzed. The success rate for dynamic fluoroscopic intraoperative cholangiography was computed, and outpatient laparoscopic common bile duct exploration and anesthetic management were reviewed.
  
  
  METHODS
  Patient charts from the ambulatory surgery center, office, and hospital were reviewed over a 4-year period commencing in October 1999. All cases were performed by 1 of 3 surgeons who are experienced with outpatient laparoscopic cholecystectomy and practice routine dynamic fluoroscopic intraoperative cholangiography.
  
  
  RESULTS
  A total of 338 laparoscopic cholecystectomies were performed. Dynamic fluoroscopic intraoperative cholangiography was successfully performed in 89% (n = 302). No instances of bile duct injury or conversions to open surgery were reported. A 0.89% (n = 3) incidence of postoperative bile leak occurred. Six patients were admitted for inpatient care for a rate of 1.78%. Choledocholithiasis occurred in 2.0% and was managed successfully in the ambulatory setting.
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy can be adapted to the freestanding ambulatory surgery environment with very high standards of care and very low complication rates.
authors.affiliation: Center for Ambulatory Surgery and Endoscopy of Southeastern New Mexico, Roswell, New Mexico, USA. wenner@lapsurgical.com
authors.forename: Donald E
authors.initials: DE
authors.lastname: Wenner
authors.forename: Paul
authors.initials: P
authors.lastname: Whitwam
authors.forename: David
authors.initials: D
authors.lastname: Turner
authors.forename: Amrita
authors.initials: A
authors.lastname: Chadha
authors.forename: Jason
authors.initials: J
authors.lastname: Degani
mesh_terms: D000328:Adult; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000209:etiology / Q000628:therapy; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013531:Surgicenters; D013997:Time Factors