title: [Observational study on outpatient sleeve gastrectomy].
abstract: The development of outpatient surgery is one of the major goals of the public health policy in 2010. The purpose of this observational study is to evaluate the feasibility of the laparoscopic sleeve gastrectomy (LSG) in ambulatory.
  
  
  METHODS
  This prospective observational study was conducted from May 2011 to June 2013. The procedure was proposed for patients undergoing LSG who were predetermined inclusion criteria. Following preoxygenation, anaesthesia was induced with propofol and sufentanil. Tracheal intubation was facilitated with rocuronium. Anaesthesia was maintained with desflurane and remifentanil target-controlled infusion. Antiemetic prophylaxis was supplied with intravenous (IV) droperidol and dexamethasone; postoperative pain prophylaxis was IV paracetamol, nefopam, tramadol, and ropivacaine infiltration. The patients were extubated in the operating room and kept in the postoperative care unit. A water-soluble contrast examination was performed in the output of the postoperative care unit. Oral feeding was resumed immediately in the absence of fistula on this leak test in an ambulatory surgical unit. When the patient has satisfied the modified Post-Anaesthesia Discharge Scoring System (PADSS) criteria, he or she can then be discharged and sent home.
  
  
  RESULTS
  Among 280 patients operated on for obesity by laparoscopic sleeve gastrectomy during the study period, 68 (24.2 %) underwent ambulatory procedure. Of the 68 obese patients, 94.1 % were female. Mean age was 34.4 years (22-55). Mean preoperative BMI was 42.6kg/m(2). Thirteen patients (19.1 %) had HTN; 7 (10.2 %) had dyslipidemia and 6 (8.8 %) had diabetes not requiring treatment. The mean operating time was 60minutes (range, 45-95) and there were no conversions to open surgery. No intra-operative anesthetic or surgical complications occurred. Mean time in the recovery room was 86.5minutes (35-240). The overall satisfaction rate was 92.6 % (n=63). No patients were admitted because of nausea or inadequate pain control. There were no re-admissions or hospitalizations were reported. We recorded five surgical complications including two case of gastric fistula, one case of gastric stenosis, one case of scar dehiscence and one case of splenic upper pole ischemia. Its complications have arisen from the fourth postoperative day. This does not undermine the ambulatory procedure.
  
  
  CONCLUSIONS
  The laparoscopic sleeve gastrectomy in ambulatory is feasible with a dedicated anesthesiological concept in an expert surgical team. Appropriate patient selection is important in order to secure safety and quality of care within outpatient program. The risk versus benefit must be adequately evaluated on an individual basis.
authors.affiliation: Pôle d'anesthésie réanimation, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France. Electronic address: badaoui.rachid@chu-amiens.fr.
authors.forename: R
authors.initials: R
authors.lastname: Badaoui
authors.affiliation: Service de chirurgie digestive oncologique et métabolique, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: L
authors.initials: L
authors.lastname: Rebibo
authors.affiliation: Pôle d'anesthésie réanimation, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: V
authors.initials: V
authors.lastname: Thiel
authors.affiliation: Pôle d'anesthésie réanimation, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: C
authors.initials: C
authors.lastname: Perret
authors.affiliation: Pôle d'anesthésie réanimation, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: I
authors.initials: I
authors.lastname: Popov
authors.affiliation: Service de chirurgie digestive oncologique et métabolique, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: A
authors.initials: A
authors.lastname: Dhahri
authors.affiliation: Service de chirurgie digestive oncologique et métabolique, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Regimbeau
authors.affiliation: Service de chirurgie digestive oncologique et métabolique, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: P
authors.initials: P
authors.lastname: Verhaeghe
authors.affiliation: Pôle d'anesthésie réanimation, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: H
authors.initials: H
authors.lastname: Dupont
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery; D009767:Obesity, Morbid / Q000601:surgery; D010349:Patient Compliance; D019990:Perioperative Care; D010549:Personal Satisfaction; D011182:Postoperative Care; D011446:Prospective Studies; D055815:Young Adult
keywords: Ambulatory anesthesia; Anesthésie ambulatoire; Bariatric surgery; Chirurgie bariatrique; Laparoscopie; Laparoscopy; Obesity; Obésité; Outpatient; Sleeve gastrectomy