title: Day case laparoscopic incisional hernia repair is feasible, acceptable, and cost effective.
abstract: BACKGROUND
  Day case surgery is increasingly performed in the United Kingdom. Laparoscopic techniques have increased the number of conditions suitable for a day surgical approach. Findings have shown that laparoscopic incisional hernia repair (LIHR) is superior to conventional open techniques. This study aimed to show that day case LIHR is safe, produces a good clinical outcome, and is cost effective.
  
  
  METHODS
  Day case laparoscopic repair was performed for 31 consecutive patients (10 men; median age, 67 years; range, 39-80 years). Data were entered prospectively into a database. Patients were discharged within 8 h committed to a 10-day course of oral diclofenac 50 mg three times daily and 2 tablets of codydramol four times daily. Follow-up evaluation was by telephone consultation. Hospital costs for LIHR and open repair were compared.
  
  
  RESULTS
  All procedures were completed laparoscopically on a day case basis. Additional unsuspected defects were found in eight cases (25.8%). The median mesh size was 140 cm2 (range, 25-375 cm2), and the median body mass index (BMI) was 28.7 kg/m2 (range, 20-37.1 kg/m2). Operations were performed or supervised by a single consultant surgeon (S.J.W.). Six postoperative seromas resolved spontaneously. Two port-site infections required oral antibiotics, and one diathermy pad burn healed with simple dressings. The median analgesia requirement was 7 days (range, 0-152 days). There were no recurrences during a median follow-up period of 15 months (range, 3-24 months). There was a saving of 616 pounds sterling per procedure.
  
  
  CONCLUSIONS
  Day case laparoscopic repair of incisional hernias is feasible and safe and has a good clinical outcome. The hospital costs are less than for open techniques.
authors.affiliation: Department of Laparoscopic Surgery, Chase Farm Hospital, Enfield, United Kingdom. alecengledow@hotmail.com
authors.forename: A H
authors.initials: AH
authors.lastname: Engledow
authors.forename: N
authors.initials: N
authors.lastname: Sengupta
authors.forename: F
authors.initials: F
authors.lastname: Akhras
authors.forename: M
authors.initials: M
authors.lastname: Tutton
authors.forename: S J
authors.initials: SJ
authors.lastname: Warren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000191:economics; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002056:Burns / Q000209:etiology / Q000503:physiopathology; D003972:Diathermy / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D012075:Remission, Spontaneous; D049291:Seroma / Q000209:etiology / Q000503:physiopathology; D013530:Surgical Wound Infection / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000900:Anti-Bacterial Agents