title: Day-case laparoscopic ventral rectopexy: an achievable reality.
abstract: OBJECTIVE
  Laparoscopic ventral rectopexy (LVR) is a non-resectional technique for selected patients with full-thickness rectal prolapse and obstructed defaecation syndrome. Despite its challenges, LVR can be performed with relatively minimal patient trauma thus creating the potential for same-day discharge. Our aim was to assess the safety of day-case LVR and identify factors associated with same-day discharge.
  
  
  METHODS
  Data were prospectively collected on all patients (n = 120) from June 2008 to October 2011. Variables included demographics, perioperative details and postoperative course. Primary outcome was length of stay and secondary outcome was symptom improvement at the latest outpatient follow-up. Patients discharged the same day after LVR were compared with those who stayed overnight or longer.
  
  
  RESULTS
  Indications included rectocele and internal prolapse (47%), full-thickness rectal prolapse (44%) and other (9%). Mean operative time was 97 min, same-day discharge occurred with 23% (n = 27) and 67% (n = 80) were discharged on postoperative day 1. In terms of complications, 89% had none, 8% minor and 3% major, including one 24-h readmission for pain. Logistic regression identified younger age (P = 0.054) and private insurance status (P < 0.001) as being significantly associated with same-day discharge. Although surgical indication (P < 0.001), no prior hysterectomy (P = 0.012) and use of biological mesh (P = 0.012) had significant association they were probably confounded by age.
  
  
  CONCLUSIONS
  In selected patients with rectal prolapse or obstructed defaecation, same-day discharge after LVR is feasible and safe. Our analysis identified quicker discharge in the private system with younger patients. Nevertheless, in unselected patients 90% were discharged by the first operative day.
authors: Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors: M P
authors: MP
authors: Powar
authors: J W
authors: JW
authors: Ogilvie
authors: A R L
authors: AR
authors: Stevenson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003248:Constipation / Q000209:etiology / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D018579:Patient Selection; D011183:Postoperative Complications; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000150:complications / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D013526:Surgical Mesh; D016896:Treatment Outcome