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Kaushik C, Milhoan M, Khanna A, Miller A, Chawla M, Miller CC, Banki F. Laparoscopic Heller myotomy and Dor fundoplication in the same day surgery setting with a trained team and an enhanced recovery protocol. Surg Open Sci 2020; 1:64-68. [PMID: 32754694 PMCID: PMC7391888 DOI: 10.1016/j.sopen.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/10/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022] Open
Abstract
Background The length of stay after Heller myotomy is 1–5 days. The aim was to report feasibility of the procedure as same day surgery (SDS). Methods Three steps of Enhanced Recovery After Surgery protocol: preoperatively, clear liquid diet for 24 hours, in preoperative area: antiemetics as dermal patch/IV form, 2: Intraoperatively, intubation in semi upright position, IV analgesics and antiemetics. 3: Postoperatively, clear liquid diet and discharge instructions. Patients were followed using a phone questionnaire. Values are median (interquartile range). Results Fifty-seven patients, 32 M (56%)/25F (44%), age 48 (35–59). First 45 were inpatient with LOS of 1 day. Last 12 were planned as same day surgery, 1/12 was discharged on POD#2, 11/12 (92%) were performed as same day surgery. The duration of operation: 139.5 min (114–163) inpatient: vs 123 (107–139) same day surgery, P < .01. Questionnaires were obtained in 78% inpatient at 40 months (25.6–67) vs 82% same day surgery at 8 (4–12). All were satisfied with the operation with no difference between the 2 groups. Conclusion Heller myotomy can be planned as same day surgery and performed successfully in majority of patients with a trained team and an Enhanced Recovery After Surgery protocol focused on prevention of nausea, and pain control in perioperative period.
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Affiliation(s)
- Chandni Kaushik
- McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth)
| | - Madison Milhoan
- McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth)
| | - Anshu Khanna
- McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth)
| | - Andre Miller
- Memorial Hermann Southeast Esophageal Disease Center
| | - Munish Chawla
- Memorial Hermann Southeast Esophageal Disease Center
| | - Charles C Miller
- McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth)
| | - Farzaneh Banki
- McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth).,Memorial Hermann Southeast Esophageal Disease Center
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Kim MP, Godoy C, Nguyen DT, Meisenbach LM, Chihara R, Chan EY, Graviss EA. Preemptive pain-management program is associated with reduction of opioid prescriptions after benign minimally invasive foregut surgery. J Thorac Cardiovasc Surg 2020; 159:734-744.e4. [DOI: 10.1016/j.jtcvs.2019.06.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 01/20/2023]
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Mistry P, Zaman S, Shapey I, Daskalakis M, Nijjar R, Richardson M, Super P, Singhal R. Building a model for day case hiatal surgery - Lessons learnt over a 10 year period in a high volume unit: A case series. Int J Surg 2018; 54:82-85. [PMID: 29704563 DOI: 10.1016/j.ijsu.2018.04.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/23/2018] [Accepted: 04/23/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic anti-reflux surgery has become the standard treatment for symptomatic gastro-oesophageal reflux disease refractory to medical therapy. Successful anti-reflux surgery involves safe, minimally invasive surgery, resulting in symptom resolution with minimal side effects. This study aims to assess the feasibility and safety of day case anti-reflux surgery focussing on peri- and post-operative outcomes as a measure of success. METHODS Data was collected from the hospital database from 2003 to 2012. Data collection included demographics, surgeon, mode of admission, length of stay and complications. Electronic records were independently scrutinised for all patients with a length of stay of more than two nights. RESULTS 723 patients underwent laparoscopic fundoplication ± small hiatus hernia repair (<5 cm) with a day case rate of 67.1%. The 30 day readmission rate in these patients was 2.9% (21/723 patients). Nine patients had a failure of their initial laparoscopic fundoplication (defined as recurrence of symptoms). Three patients required a re-operation within 12 months of their initial procedure (re-operation rate = 0.41% (3/723 patients)). CONCLUSION Laparoscopic hiatal surgery can be performed safely as a day case in high volume specialist centres with good outcomes. Raising the national standard for day case fundoplication promotes good practice and should be the model for future commissioning.
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Affiliation(s)
- Pritesh Mistry
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK.
| | - Shafquat Zaman
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Iestyn Shapey
- Department of Transplantation, Manchester Royal Infirmary, Manchester, UK
| | - Markos Daskalakis
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Rajwinder Nijjar
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Martin Richardson
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Paul Super
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Rishi Singhal
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK
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An "all 5 mm ports" technique for laparoscopic day-case anti-reflux surgery: A consecutive case series of 205 patients. Int J Surg 2016; 35:214-217. [PMID: 27697465 DOI: 10.1016/j.ijsu.2016.09.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Laparoscopic anti-reflux surgery is conventionally performed using two 10/12 mm ports. While laparoscopic procedures reduce post-operative pain, the use of larger ports invariably increases discomfort and affects cosmesis. We describe a new all 5 mm ports technique for laparoscopic anti-reflux surgery and present a review of our initial experience with this approach. METHODS All patients undergoing laparoscopic fundoplication over a 35 month period from February 2013 under the care of a single surgeon were included. A Lind laparoscopic fundoplication was performed using an all 5 mm port technique. Data was recorded prospectively on patient demographics, operating surgeon, surgical time, date of discharge, readmissions, complications, need for re-intervention, and reasons for admission. RESULTS Two hundred and five consecutive patients underwent laparoscopic fundoplication over the study period. The all 5 mm port technique was used in all cases, with conversion to a 12 mm port only once (0.49%). Median operating time was 52 min 185 (90.2%) patients were discharged as day cases. Increasing ASA grade and the presence of a hiatus hernia were associated with the need for overnight stay with admission required in 33% of patients with ASA 3, compared to 4% with ASA 1 (p = 0.001), and 29% of those with a hiatus hernia vs. 5% without (p < 0.001). No port-related complications occurred, and no patients developed recurrence of reflux symptoms. A single patient required mesh repair of a large hiatus hernia. CONCLUSION The all 5 mm ports approach to laparoscopic anti-reflux surgery is a safe, efficient, and cost-effective technique which facilitates same day discharge and minimises port related complications. National commissioning guidelines in the UK should target quality improvements in anti-reflux surgery based around day-case management. This would improve the service for these patients and culminate in cost savings for the NHS.
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Naumann DN, Zaman S, Daskalakis M, Nijjar R, Richardson M, Super P, Singhal R. Day surgery for achalasia cardia: Time for consensus? Ann R Coll Surg Engl 2016; 98:150-4. [PMID: 26829668 PMCID: PMC5210494 DOI: 10.1308/rcsann.2016.0063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION 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.
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Affiliation(s)
- D N Naumann
- Heart of England NHS Foundation Trust , Birmingham , UK
| | - S Zaman
- Heart of England NHS Foundation Trust , Birmingham , UK
| | - M Daskalakis
- Heart of England NHS Foundation Trust , Birmingham , UK
| | - R Nijjar
- Heart of England NHS Foundation Trust , Birmingham , UK
| | - M Richardson
- Heart of England NHS Foundation Trust , Birmingham , UK
| | - P Super
- Heart of England NHS Foundation Trust , Birmingham , UK
| | - R Singhal
- Heart of England NHS Foundation Trust , Birmingham , UK
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Shapey IM, Agrawal S, Peacock A, Super P. A prospective cross-sectional study of laparoscopic subtotal Lind fundoplication for gastro-oesophageal reflux disease--a durable and effective anti-reflux procedure. Int J Surg 2014; 13:257-260. [PMID: 25529280 DOI: 10.1016/j.ijsu.2014.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Laparoscopic partial fundoplication for gastro-oesophageal reflux disease (GORD) is reported to have fewer side effects when compared to Nissen fundoplication, but doubts remain over its long term durability in controlling reflux. The aim of this study was to assess outcome of symptoms for all patients presenting with GORD undergoing routine laparoscopic subtotal Lind fundoplication. MATERIALS & METHODS All patients undergoing laparoscopic fundoplication between August, 1999 and November, 2007 performed by a single surgeon were included in the study. The anti-reflux procedure studied was laparoscopic Lind (300°) fundoplication with crural repair in all cases. Patients completed pre and post-operative questionnaires containing validated scoring systems for heartburn, gas bloat, dysphagia and overall patient satisfaction. RESULTS Over the 100-month period, 320 consecutive patients underwent laparoscopic subtotal Lind fundoplication. Of these, 256 (80%) replied to the questionnaire at a mean of 31 months (range 3-96 months) following surgery. 91.4% of respondents had an improvement in heartburn symptom score with a significant reduction in score from 7.74 preoperatively to 1.25 postoperatively (p<0.001). There was also a significant reduction of mean modified Visick score for reflux control (heartburn and regurgitation) from 3.49 preoperatively to 1.48 after surgery (p<0.001). In total, 22 patients developed recurrent reflux symptoms with half of these reporting their recurrence within two years following surgery. Because of this all were tested with post-operative pH testing, yet only one had a 24-h pH time outside the normal range. Overall patient satisfaction was high with a visual analogue score of 9 and 88% of the patients claimed they would have the operation again. CONCLUSION Laparoscopic Lind fundoplication demonstrates excellent reflux control when performed routinely for all patients presenting with GORD. This technique is both durable and efficacious in controlling reflux symptoms.
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Affiliation(s)
- I M Shapey
- Department of Upper Gastrointestinal Surgery, Birmingham Heartland Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
| | - S Agrawal
- Department of Upper Gastrointestinal Surgery, Birmingham Heartland Hospital, Bordesley Green East, Birmingham B9 5SS, UK
| | - A Peacock
- Department of Upper Gastrointestinal Surgery, Birmingham Heartland Hospital, Bordesley Green East, Birmingham B9 5SS, UK
| | - P Super
- Department of Upper Gastrointestinal Surgery, Birmingham Heartland Hospital, Bordesley Green East, Birmingham B9 5SS, UK
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Brown JJ, Bawa S, Horgan LF, Attwood SE. Achieving Day-Case Laparoscopic Nissen Fundoplication: An Analysis of Patient and Operative Factors. J Laparoendosc Adv Surg Tech A 2013; 23:751-5. [DOI: 10.1089/lap.2013.0187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Jamie J.S. Brown
- Department of Surgery, Northumbria Healthcare NHS Trust, North Tyneside General Hospital, Tyne and Wear, United Kingdom
| | - Sidaq Bawa
- Department of Surgery, Northumbria Healthcare NHS Trust, North Tyneside General Hospital, Tyne and Wear, United Kingdom
| | - Liam F. Horgan
- Department of Surgery, Northumbria Healthcare NHS Trust, North Tyneside General Hospital, Tyne and Wear, United Kingdom
| | - Stephen E. Attwood
- Department of Surgery, Northumbria Healthcare NHS Trust, North Tyneside General Hospital, Tyne and Wear, United Kingdom
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Lal P, Leekha N, Chander J, Dewan R, Ramteke VK. A prospective nonrandomized comparison of laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication in Indian population using detailed objective and subjective criteria. J Minim Access Surg 2012; 8:39-44. [PMID: 22623824 PMCID: PMC3353611 DOI: 10.4103/0972-9941.95529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 03/23/2011] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND: Laparoscopic Nissen fundoplication (LNF) is a commonly performed procedure for the treatment of gastro esophageal reflux disease (GERD) worldwide. However, unfavourable postoperative sequel, including gas bloat and dysphagia, has encouraged surgeons to perform alternative procedures such as laparoscopic Toupet fundoplication (LTF). This prospective nonrandomized study was designed to compare LNF with LTF in patients with GERD. MATERIALS AND METHODS: Hundred and ten patients symptomatic for GERD were included in the study after having received intensive acid suppression therapy for a minimum of 8 weeks. A 24-hour pH metry was done on all patients. Fifty patients having reflux on 24-hour pH metry were taken up for the surgery. Patients were further divided into group-A (LNF) and group-B (LTF). RESULTS: The median percentage time with esophageal pH < 4 decreased from 10.18% and 12.31% preoperatively to 0.85% and 1.94% postoperatively in LNF and LTF-groups, respectively. There was a significant and comparable increase in length of lower esophageal sphincter (LES), length of intraabdominal part of LES and LES pressure at respiratory inversion point in both the groups. In LNF-group, five patients had early dysphagia that improved afterwards. There were no significant postoperative complications. CONCLUSION: LNF and LTF are highly effective in the management of GERD with significant improvement in symptoms and objective parameters. LNF may be associated with significantly higher incidence of short onset transient dysphagia that improves with time. Patients in both the groups showed excellent symptom and objective control on 24-hour pH metry on short term follow-up.
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Affiliation(s)
- Pawanindra Lal
- Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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Abstract
Gastroesophageal reflux (GER) affects ∼10-20% of American adults. Although symptoms are equally common in men and women, we hypothesized that sex influences diagnostic and therapeutic approaches in patients with GER. PubMed database between 1997 and October 2011 was searched for English language studies describing symptoms, consultative visits, endoscopic findings, use and results of ambulatory pH study, and surgical therapy for GER. Using data from Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, we determined the sex distribution for admissions and reflux surgery between 1997 and 2008. Studies on symptoms or consultative visits did not show sex-specific differences. Even though women are less likely to have esophagitis or Barrett's esophagus, endoscopic studies enrolled as many women as men, and women were more likely to undergo ambulatory pH studies with a female predominance in studies from the US. Surgical GER treatment is more commonly performed in men. However, studies from the US showed an equal sex distribution, with Nationwide Inpatient Sample data demonstrating an increase in women who accounted for 63% of the annual fundoplications in 2008. Despite less common or severe mucosal disease, women are more likely to undergo invasive diagnostic testing. In the US, women are also more likely to undergo antireflux surgery. These results suggest that healthcare-seeking behavior and socioeconomic factors rather than the biology of disease influence the clinical approaches to reflux disease.
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Thomas H, Agrawal S. Systematic review of day-case laparoscopic fundoplication. J Laparoendosc Adv Surg Tech A 2011; 21:781-8. [PMID: 21942361 DOI: 10.1089/lap.2011.0276] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of the current study is to review published literature on day-case laparoscopic fundoplication in adults. DATA SOURCES Medline, Embase, and Cochrane library was searched by using the medical subjects headings "ambulatory surgical procedures" and "fundoplication" with further free text search and cross references. All articles on planned day-case laparoscopic fundoplication that described patient selection criteria, same-day discharge, complications, and readmissions were reviewed. CONCLUSIONS Thirteen cohort studies were included in this review. Ten were on planned same-day discharge with a 93% (739 out of 792) success, 4% (34) complication, and 5% (39) readmission rate. Three studies were on planned 23 hour discharge with a 98% (571 out of 583) success, 4% (25) complications, and 1% (5) re-admission rate. Nausea, pain, fatigue, and pneumothorax were the commonest causes for overnight admission. Dysphagia and pain were the main reasons for readmission. Most patients were satisfied with day-case laparoscopic fundoplication.
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Affiliation(s)
- Harun Thomas
- The Academic Unit of Surgical Gastroenterology, Homerton University Hospital NHS Trust, London, United Kingdom
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Ambulatory laparoscopic fundoplication for gastroesophageal reflux disease: a systematic review. Surg Endosc 2011; 25:2859-64. [PMID: 21487865 DOI: 10.1007/s00464-011-1682-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 03/14/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ambulatory laparoscopic fundoplication for gastroesophageal reflux disease (GERD) has been developed in order to increase patients' satisfaction and to save bed costs. The aim of this systematic review was to assess the advantages and disadvantages of ambulatory surgery in patients undergoing elective fundoplication for GERD. METHODS Two reviewers independently searched and identified 15 prospective or retrospective nonrandomized studies dealing with ambulatory laparoscopic fundoplication for GERD in the Medline, Cancerlit, and Embase databases between January 1990 and July 2010. Outcomes were postoperative mortality, morbidity, conversion and reoperation rates, mean operative time, hospital admission or readmission, unexpected consultation, and patient satisfaction. Because only one comparative study was identified, data compilation and relative risk evaluation through meta-analysis were not possible. RESULTS A total of 1459 adult patients underwent an ambulatory laparoscopic fundoplication for GERD, 876 in a day-case setting and 583 in an outpatient setting. The procedure appears feasible for selected patients and expert surgeons, and it has a very low mortality rate and conversion, reoperation, and overall morbidity rates of 3.6, 0.6, and 11.1%, respectively. Hospital admission, nonprogrammed consultation, and hospital readmission rates were as high as 20, 11, and 12%, respectively. No study looked at comparative long-term functional results between ambulatory and inpatient procedures. Patient satisfaction rates based on self-evaluation were high. CONCLUSION The data available to date in the literature, mostly of level 4 evidence, suggest that laparoscopic fundoplication for GERD appears to be safe and feasible in a day-surgery setting, subject to careful patient selection and surgeon expertise. Randomized control trials are urgently needed to better evaluate this promising care management.
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Thomas H, Agrawal S. Systematic Review of Same-Day Laparoscopic Adjustable Gastric Band Surgery. Obes Surg 2011; 21:805-10. [DOI: 10.1007/s11695-011-0384-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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