title: Day surgery for achalasia cardia: Time for consensus?
abstract: BACKGROUND
  Laparoscopic Heller's myotomy (LHM) is the most effective therapy for achalasia of the oesophagus. Most case series of LHM report a length of hospital stay (LOS) >1 day. We present 14 years of experience of LHM to examine the safety and feasibility of LHM as a day case procedure.
  
  
  METHODS
  We retrospectively examined patients undergoing elective LHM for achalasia at our institution between 2000 and 2014. Demographics, episode statistics, prior investigations and interventions were collated. Outcomes, including LOS, complications and re-interventions, were compared for the periods before and after a consensus decision at our institution in 2008 to perform LHM as a day case procedure.
  
  
  RESULTS
  Sixty patients with a mean age of 41 ± 13 years were included, of whom 58% were male. The median LOS for all patients was 1 day (interquartile range [IQR] 0-2.25). Overall, LHM was performed as a day case in 27 (45%) cases, at 2/26 (7.7%) in the first period versus 25/34 (73.5%) in the second (p<0.01). There were no significant differences in age, gender or previous interventions between day surgery and non-day surgery groups. One patient required subsequent unplanned surgery, while six (10%) needed endoscopic treatment of recurrent symptoms within 12 months.
  
  
  CONCLUSIONS
  LHM can be performed safely as a day case procedure. Complication rates are low, with only a small proportion of patients requiring endoscopic treatment for symptom recurrence within 1 year.
authors.affiliation: Heart of England NHS Foundation Trust , Birmingham , UK.
authors.forename: D N
authors.initials: DN
authors.lastname: Naumann
authors.affiliation: Heart of England NHS Foundation Trust , Birmingham , UK.
authors.forename: S
authors.initials: S
authors.lastname: Zaman
authors.affiliation: Heart of England NHS Foundation Trust , Birmingham , UK.
authors.forename: M
authors.initials: M
authors.lastname: Daskalakis
authors.affiliation: Heart of England NHS Foundation Trust , Birmingham , UK.
authors.forename: R
authors.initials: R
authors.lastname: Nijjar
authors.affiliation: Heart of England NHS Foundation Trust , Birmingham , UK.
authors.forename: M
authors.initials: M
authors.lastname: Richardson
authors.affiliation: Heart of England NHS Foundation Trust , Birmingham , UK.
authors.forename: P
authors.initials: P
authors.lastname: Super
authors.affiliation: Heart of England NHS Foundation Trust , Birmingham , UK.
authors.forename: R
authors.initials: R
authors.lastname: Singhal
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D002299:Cardia / Q000601:surgery*; D032921:Consensus; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: Achalasias; Ambulatory Surgery; Esophageal; Laparoscopy; Surgery, day
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