Ambulatory transcylindrical cholecystectomy via minilaparotomy under different anesthetic techniques

Abstract

Introduction: Laparoscopic cholecystectomy is widely performed in ambulatory surgery, whereas minilaparotomy approaches remain underreported. This study evaluates the outcomes of transcylindrical cholecystectomy (TCC), performed with a cylindrical retractor, in an outpatient setting under different anesthetic techniques.

Methods: Prospective observational study of 1626 patients with cholelithiasis or related complications who underwent right transrectal epigastric minilaparotomy (4.5 cm), using a cylindrical retractor with a methacrylate plunger for direct visualization and stable exposure of the hepatocystic triangle. Anesthetic modality (general, supraglottic device, local with sedation, or spinal) was tailored to each patient. Intraoperative cholangiography was selectively performed.

Results: A total of 1626 patients underwent TCC: 916 with orotracheal intubation, 152 with supraglottic device, 503 under local anaesthesia with sedation, and 55 with spinal anaesthesia. Mean age: 59 years; BMI: 30; operative time: 40 min. The substitution index was 69%. Conversion occurred in 15 cases (0.9%), with 90 unplanned admissions (5.5%), 8 postoperative bile leaks (0.5%), 37 wound infections (2.2%), 2 deaths (0.1%), and 1 major bile duct injury (0.06%). There were 15 readmissions (0.9%) and 8 reoperations (0.5%). At 24 h, 78% of patients reported good or excellent physical condition.

Conclusions: Transcylindrical cholecystectomy is a fast, safe, and cost-effective technique for treating cholelithiasis in the ambulatory setting. It is feasible under minimally invasive anaesthesia, with low complication rates, and may be particularly valuable in resource-limited environments.

Keywords: Ambulatory surgery; Anestesia local y sedación; Cirugía mayor ambulatoria; Colecistectomía por minilaparotomía; Colecistectomía transcilíndrica; Local anesthesia and sedation; Minilaparotomy cholecystectomy; Minimally invasive surgery; Transcylindrical cholecystectomy.