Day case laparoscopic rectopexy is feasible, safe, and cost effective for selected patients

Abstract

With the ever-present financial and bed pressures in the UK health care system, there is a drive toward increasing day surgery provision. Laparoscopic minimally invasive surgery lends itself well to the day case setting. This study aimed to show that day case laparoscopic rectopexy (DCLR) is safe, produces a good clinical outcome, and is cost effective for selected well-motivated patients. Since 2001, 28 patients have undergone procedures for rectal prolapse at the authors' institution. Of 12 laparoscopic rectopexy patients, 5 were selected for DCLR on the basis of home circumstances, general fitness, and patient wishes. Patient satisfaction with DCLR was assessed by telephone questionnaire. A retrospective analysis of case notes was performed to compare complications, analgesia requirements, and length of hospital stay. In-hospital costs for all rectal prolapse procedures were calculated. The DCLR group consisted of generally younger and fitter patients. One patient in the DCLR group had persistent abdominal pain and diarrhea requiring an emergency visit. Four of the five patients in the DCLR group were available for telephone interview. Three had stopped analgesia by the third day, reporting their experience as excellent or good. They had no hesitation recommending the procedure for day case usage. Whereas Delorme's procedure and inpatient laparoscopic rectopexy cost much the same, there is a clear cost benefit with DCLR for selected patients of approximately pound1,000 ($1,962) per patient. Day case laparoscopic rectopexy has never been reported previously. It is safe, feasible, and acceptable for selected well-motivated patients. Compared with Delorme's procedure and inpatient laparoscopic rectopexy, savings of pound1,000 per patient can be achieved because of an average 3-day decrease in bed occupancy.