The safety of the same-day discharge for selected patients after laparoscopic fundoplication: a prospective cohort study.
BACKGROUND
We conducted a prospective cohort study to assess the acceptability, feasibility and safety of day-case laparoscopic fundoplication for gastroesophageal reflux disease in an university-based tertiary care center.


METHODS
The procedure was proposed as routine for patients with proven symptomatic uncomplicated gastroesophageal reflux disease fulfilling predetermined inclusion criteria from September 2003 to December 2005. Standard anesthetic, surgical, analgesic, and antiemetic protocols were used. Acceptability, admission, complication, and reoperation rates and patient satisfaction were evaluated. Postoperative pain and nausea were assessed using an 11-point numeric rating scale (NRS). The Gastrointestinal Quality of Life Index (GIQLI) was administered before and after surgery.


RESULTS
Among 100 patients screened, 40 (40%) were included. Seven patients were admitted because of inadequate pain control (n = 3), nausea or vomiting (n = 3), or anxiety (n = 1); 33 were discharged as planned 6 to 8 hours after operation. Only 1 patient was readmitted and reoperated because of fundoplicature migration following uncontrolled vomiting. At follow-up, 92.5% of patients were satisfied with the day-case treatment. If offered a similar operation in the future, 82.5% of patients would have accepted day-case treatment. The Gastrointestinal Quality of Life Index was 90.7 (+/-21.2) preoperatively compared with 105.8 (+/-21.8) postoperatively (P < .001).


CONCLUSIONS
Day-case laparoscopic fundoplication is feasible in selected patients. However, (1) strict control of postoperative nausea and pain is essential, and (2) preoperative standardized education program for ambulatory surgery might be useful in order to enhance patient acceptability and satisfaction rates.
Mariette
Christophe
C
Department of Digestive and General Surgery, C. Huriez Hospital-University Hospital Center, Place de Verdun 59037, Lille cedex, France. c-mariette@chru-lille.fr
Piessen
Guillaume
G
Balon
Jean Michel
JM
Guidat
Anne
A
Lebuffe
Gilles
G
Triboulet
Jean Pierre
JP
D000293:Adolescent; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D018579:Patient Selection; D011446:Prospective Studies