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Day-case laparoscopic Nissen fundoplication

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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.

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Authors and Affiliations

  1. North Tyneside Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK

    C. D. Jensen, A. D. Gilliam, L. F. Horgan, S. Bawa & S. E. Attwood

  2. James Cook University Hospital, Middlesborough, UK

    A. D. Gilliam

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  1. C. D. Jensen
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  2. A. D. Gilliam
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  3. L. F. Horgan
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  4. S. Bawa
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  5. S. E. Attwood
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Correspondence to A. D. Gilliam.

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Jensen, C.D., Gilliam, A.D., Horgan, L.F. et al. Day-case laparoscopic Nissen fundoplication. Surg Endosc 23, 1745–1749 (2009). https://doi.org/10.1007/s00464-008-0178-4

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  • DOI: https://doi.org/10.1007/s00464-008-0178-4

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