Day-case laparoscopic fundoplication for gastro-oesophageal reflux disease.
BACKGROUND
Based on a series of successful outpatient laparoscopic cholecystectomies, day-case laparoscopic fundoplication for gastro-oesophageal reflux disease was introduced in January 1997. The initial results are reported.


METHODS
Inclusion criteria were American Society of Anesthesiologists grade I-II, living within 30 min travel from the hospital, and adult company at home. Initially only selected patients were offered day-case treatment, but later it was adopted as routine. The patients underwent general intravenous anaesthesia with propofol and remifentanil, and were given ketorolac, propacetamol, droperidol and ondansetron as prophylaxis against postoperative pain and nausea. The surgical procedure was Nissen-Rosetti fundoplication or semifundoplication depending on oesophageal manometric results.


RESULTS
Forty-five patients were included. Four patients were admitted; 41 were discharged as planned 3-8 h after operation, and five of these patients were readmitted. One underwent reoperation for necrosis of the gastric fundus. A further five patients visited the outpatient department without need for admission. At follow-up 31 patients were satisfied with the day-case treatment, five were indifferent, and five were dissatisfied because of pain. If offered a similar operation in the future, 26 patients would have preferred and seven would have accepted day-case treatment, and eight would not.


CONCLUSIONS
Outpatient laparoscopic fundoplication is safe and well tolerated by the majority of patients.
Trondsen
E
E
Departments of Gastroenterological Surgery and Anaesthesiology, Ullevâl Hospital and University of Oslo, Oslo, Norway.
Mjâland
O
O
Raeder
J
J
Buanes
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004630:Emergencies; D005260:Female; D005743:Gastrectomy / Q000401:mortality*; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000601:surgery*; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality / Q000601:surgery; D010439:Peptic Ulcer Perforation / Q000401:mortality / Q000601:surgery; D012044:Regression Analysis; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000401:mortality / Q000601:surgery; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery