Day surgery and gastroenterologyDay surgery encompasses all surgical specialities and is an accepted mode of delivering surgical care. In the UK day surgery accounts for 30/O of all elective surgical cases; this is expected to increase to 50% in the near future.' In our institution the high level (90%) of patient acceptability for day surgery has led to an increased patient demand for the service. Gastroenterological surgery, which includes endoscopy, constitutes a significant proportion of the current activity and promises to be the speciality that will contribute most to the predicted increase in day surgery. In this review we examine the reasons for the increase in day surgery, the adaptations required in providing a day surgery service, the types of gastroenterological procedures being performed, and finally those procedures that may be performed in the future.Increase in day surgery activity Day surgery has been practised in this country since the beginning of the century when it was recognised that there were psychological and medical benefits to be gained from early discharge from hospital.2 It was not until the 1970s, however, that there was renewed interest in day surgery, when reports of the technical feasibility and benefits of day surgery were published by enthusiasts.3The main reason for the present increase in day surgery is the allocation of additional resources for providing dedicated facilities and personnel by health services keen on promoting day surgery. This has been driven by economic considerations, as day surgery is thought to be more cost effective and efficient than inpatient treatment, thus allowing closure of some inpatient facilities.4 The cost per general surgical patient in our day care unit is £471 compared with £571 for an inpatient stay of 48 hours. This represents a saving of 21% which is achieved in a unit adapted from existing facilities.5 Therefore, careful planning is required if the purpose built day facilities are to achieve the desired levels of usage and efficiency to justify the considerable capital expenditure. Considerable organisation is involved in the delivery of a successful day surgery service.9 Dedicated theatre lists are required so that the more complicated procedures can be performed in the morning to allow patients sufficient time to recover from surgery and be fit for discharge. Placing such patients on routine lists often leads to their delay or cancellation when inpatient procedures run over time.The general anaesthetic agents used for day surgery must allow rapid postoperative recovery and minimal postoperative nausea. We have found that the use of locoregional anaesthesia has benefits which include eliminating the risks and side effects of general anaesthesia and providing better perioperative analgesia than narcotic analgesics.Meticulous haemostasis is important as even slight bleeding provokes anxiety, which may prevent the patient from being discharged.10 Subcuticular sutures are used as they are more comfortable and do not need removing. Appropriat...
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