Surgical Endoscopy

, Volume 23, Issue 8, pp 1745–1749

Day-case laparoscopic Nissen fundoplication

  • C. D. Jensen
  • A. D. Gilliam
  • L. F. Horgan
  • S. Bawa
  • S. E. Attwood
Article

DOI: 10.1007/s00464-008-0178-4

Cite this article as:
Jensen, C.D., Gilliam, A.D., Horgan, L.F. et al. Surg Endosc (2009) 23: 1745. doi:10.1007/s00464-008-0178-4

Abstract

Introduction

Nissen fundoplication has been performed laparoscopically for over 15 years, being associated with shorter hospital stay and fewer complications than conventional open surgery with good long-term outcomes. Day-case laparoscopic Nissen fundoplication (LNF) is rarely performed in the UK and most series in the literature report length of stay >2 days.

Methods

The objective of this study was to examine the safety and efficacy of day-case LNF. The clinical records of all patients undergoing LNF under the care of three surgeons in a district general hospital (DGH) during a 5-year period (January 2003 to December 2007) were reviewed to examine length of stay, complications, length of procedure, grade of operating surgeon and symptoms on follow-up.

Results

One hundred thirteen day-case LNFs were recorded in this series. Day-case LNF patients had median age of 45 years (range 20–68 years, 65% (64.6%) male) and 98% were American Society of Anesthesiologists (ASA) grade I or II. Twenty-one cases (19%) were performed by higher surgical trainees. Median operative time was 54 minnutes (range 25–120 min). Only one perioperative complication (port-site bleed) occurred, treated without prolonging length of stay. The proportion of all LNF performed as day cases increased from 8% to 52% during the study period. Median operative time has significantly reduced from the first 20 consecutive LNF cases to the latest 20 cases [65 min (range 40–120 min) versus 48 min (range 25–72 min); p = 0.037]. At follow-up (median 7 weeks, range 2–31 weeks) 82% of patients had improvement in all presenting symptoms. Eight patients had postoperative complications [wound infection (n = 2), persistent regurgitation requiring laparoscopic division of a gastric band adhesion (n = 1), dysphagia (n = 5 with two patients requiring redo partial fundoplication and one patient requiring dilatation) and there were no conversions to open surgery.

Conclusion

Day-case LNF is safe and effective for treating selected patients with gastroesophageal reflux disease (GERD) in a DGH. The proportion of day-case LNFs is increasing in our unit. Half of the LNFs in a DGH can be done as day cases. Experience is associated with a significant reduction in operative time.

Keywords

Gastroesophageal reflux disease Laparoscopic Nissen fundoplication Day case 

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • C. D. Jensen
    • 1
  • A. D. Gilliam
    • 1
    • 2
  • L. F. Horgan
    • 1
  • S. Bawa
    • 1
  • S. E. Attwood
    • 1
  1. 1.North Tyneside Hospital, Rake LaneTyne and WearUK
  2. 2.James Cook University HospitalMiddlesboroughUK

Personalised recommendations