Building a model for day case hiatal surgery - Lessons learnt over a 10 year period in a high volume unit: A case series. (June 2018)

• Record Type: Journal Article
• Authors: Mistry, Pritesh; Zaman, Shafquat; Shapey, Iestyn; Daskalakis, Markos; Nijjar, Rajwinder; Richardson, Martin; Super, Paul; Singhal, Rishi
• Is Part Of: International journal of surgery. Volume 54(2018)Part A
• Page Start: 82
• Page End: 85
• Publication Date: 2018-06
• Subjects: Gastro oesophageal reflux disease -- Fundoplication -- Hiatus hernia; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2018.04.039
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: Laparoscopic anti-reflux surgery has become the standard treatment for symptomatic gastro-oesophageal reflux disease refractory to medical therapy. Successful anti-reflux surgery involves safe, minimally invasive surgery, resulting in symptom resolution with minimal side effects. This study aims to assess the feasibility and safety of day case anti-reflux surgery focussing on peri- and post-operative outcomes as a measure of success. Methods: Data was collected from the hospital database from 2003 to 2012. Data collection included demographics, surgeon, mode of admission, length of stay and complications. Electronic records were independently scrutinised for all patients with a length of stay of more than two nights. Results: 723 patients underwent laparoscopic fundoplication ± small hiatus hernia repair (<5 cm) with a day case rate of 67.1%. The 30 day readmission rate in these patients was 2.9% (21/723 patients). Nine patients had a failure of their initial laparoscopic fundoplication (defined as recurrence of symptoms). Three patients required a re-operation within 12 months of their initial procedure (re-operation rate = 0.41% (3/723 patients)). Conclusion: Laparoscopic hiatal surgery can be performed safely as a day case in high volume specialist centres with good outcomes. Raising the national standard for day case fundoplication promotes good practice and should be the model for future commissioning. Highlights: 723 patients under laparoscopic anti-reflux surgery over a 10 year period with a re-operation rate of 0.41%. Overall there was a 67.1% rate of same day discharge (81% in the last year of the study). A dedicated unit allows high quality anti-reflux surgery to be performed in the ambulatory setting.