Outcome of day-case laparoscopic fundoplication for gastro-esophageal reflux disease

Abstract

To assess the acceptability, feasibility and results of day-case laparoscopic fundoplication for gastro-esophageal reflux disease (GERD) in an university tertiary care center. Day-case surgery for GERD was proposed routinely to all patients with proven asymptomatic, uncomplicated GERD fulfilling predetermined inclusion criteria from September 2003 and January 2007. All patients underwent standard anesthetic, surgical, analgesic and antiemetic protocols. Patients had a 360° Nissen-Rosetti laparoscopic fundoplication. Evaluation, according to intent-to-treat analysis, included inclusion criteria, admission to conventional hospital facilities, unplanned post-operative consultation or readmission, complication and reoperation rates as well as patient satisfaction at 12 months, using the validated Visick score and Gastro-Intestinal Quality of Life Index (GIQLI) questionnaire. Of 152 patients undergoing laparoscopic fundoplication for GERD during the study period, 49 (32.2%) had day-case procedures. Forty patients (81.6%) were discharged 6 to 8h after operation. Nine patients were converted to in-patient hospitalization because of nausea (n=5), inadequate pain control (n=3) or anxiety (n=1), seven (77.8%) of these were discharged within 23h. Unplanned consultation or hospitalization was necessary in 14.3% and 4.1% of cases respectively, mainly for dysphagia. The postoperative complication rate was 6.1%. At 12 months, 89.6% of patients were Visick 1 to 3 (excellent to satisfactory results). Reoperation was needed in three cases. Patient quality of life, evaluated by GIQLI, was significantly enhanced by surgery (88.9±27.3 preoperatively versus 111.2±24.0 postoperatively, P<0.001). Day-case laparoscopic fundoplication for GERD is feasible and well tolerated in selected patients.