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.
Background
Recurrent hiatal hernia remains a challenge.
Methods
For initial repairs at our center: patients with 1 repair were compared to those who required reoperation for symptomatic recurrence. Subsequently, patients who had 1 repair at our center were compared to all patients who required reoperation (including initial repair at another center).
Results
There were 401 repairs: 308 primary repairs at our center and 93 reoperations, 287/308 (93%) required 1 repair and 21/308 (7%) required reoperation. Comparing 1 repair versus 21 reoperations, risk factors were abdominoplasty odds ratio = 32.0 (4.1–250.6), P < .001, postoperative lifting/vomiting odds ratio = 11.6 (3.2–42.1), P < .0002, tubal ligation odds ratio = 4.9 (1.1–22.6), P < .04 and height < 160 cm odds ratio = 3.9 (1.1–13.3) P < 0.03. Comparing 287 with 1 repair versus all 93 reoperations, risk factors were post-operative vomiting odds ratio = 22.7 (2.3–218.0), P < .007, abdominoplasty odds ratio = 5.6 (1.0–31.4), P < .0495, post-operative lifting odds ratio = 5.4 (2.2–12.9), P < .0002, age < 52 odds ratio = 3.6 (1.8–7.3), P < .0003, tubal ligation odds ratio = 3.2 (1.2–8.7), P < 0.019 and height < 160 cm odds ratio = 3.0 (1.5–6.1), P < 0.003.
Conclusions
Younger age, shorter stature, heavy lifting or vomiting after surgery, abdominoplasty and tubal ligation are risk factors associated with symptomatic recurrence requiring reoperation.
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