Laparoscopic hiatal hernia repair as same day surgery: Feasibility, short-term outcomes and costs

Gutierrez, Rigoberto; Neill, Colleen O'; Khanna, Anshu; Miller, Andre; Banki, Farzaneh

doi:10.1016/j.amjsurg.2020.09.009

Cited by 9 publications

(7 citation statements)

References 12 publications

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“…Using the power of ACS-NSQIP database, this is now one of the largest retrospective analyses examining the role of ambulatory surgery for patients undergoing laparoscopic foregut surgery. Uncomplicated laparoscopic foregut surgery is commonly performed with a hospital stay of at least 1 day [10,11]. However, in this study, we found that well selected patients undergoing uncomplicated laparoscopic foregut surgery had no differences in objective perioperative outcomes regardless if they were discharged on the day of surgery or post-operative day one.…”

Section: Discussionmentioning

confidence: 53%

“…A systematic review of the data was published in 2011 that included 13 different studies, 10 of which looked at planned same day discharge (792 patients) and 3 on planned 23 h discharge (583 patients) [12]. In contrast, there are only a handful of smaller cohort studies looking the safety and feasibility of same day discharge for laparoscopic Heller myotomy as well as paraesophageal hernia repair in select populations [6,10,11,13,14]. Our study population was a group of patients that we deemed low risk for ambulatory surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Multimodal pain control, early PO intake, and aggressive control and mitigation of post-operative nausea and vomiting (PONV) used in ERAS protocols can be applied to laparoscopic hiatal surgery in order to help facilitate same day discharge. Previous studies that have looked at why patients undergoing laparoscopic hiatal surgery who were planned to be discharged later that day do not end up going home and found that PONV, poorly controlled pain secondary to both incisional pain and diaphragmatic irritation from insufflation, and patient preference to be the main reasons for overnight admission [10,11]. There are known anesthetic techniques that can be implemented during the perioperative period to reduce PONV.…”

Section: Discussionmentioning

confidence: 99%

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Same day discharge does not lead to worse outcomes in patients undergoing uncomplicated laparoscopic foregut surgery

et al. 2022

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Introduction With the advancement of minimally invasive surgical techniques surgeons have moved away from elective open foregut surgeries. Despite studies demonstrating the safety of same day discharge in appropriate patient populations, ambulatory surgery has yet to be established as the practice norm for patients undergoing uncomplicated laparoscopic foregut surgery. Methods The ACS-NSQIP database was queried from 2005 to 2018 for patients who had undergone elective and non-emergent laparoscopic Heller myotomy, fundoplication, and paraesophageal hernia repairs with and without mesh. The primary endpoints in this study included number and severity of complications as classified by the Clavien-Dindo Classification, readmission, and return to the operating room. Results 6893 patients who met inclusion criteria were identified, 696 (10.1%) of which were discharged on the day of surgery. Patients who were discharged on post-operative day one were matched at a 3:1 ratio producing 2088 comparisons. There was no difference in overall morbidity (p = 0.264), readmission (OR 0.849, 95% CI 0.522-1.419), or return to the operating room (OR 1.15,) between the two groups. Conclusion Same day discharge for patients without life threatening comorbidities undergoing elective minimally invasive Heller myotomy, Nissen and Toupet fundoplication, and paraesophageal hernia repairs is safe and feasible.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Same day discharge does not lead to worse outcomes in patients undergoing uncomplicated laparoscopic foregut surgery

et al. 2022

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“…Though these have been studied in the past, most studies have strict selection criteria often left to the discretion of the operating surgeon or only evaluated a single type of surgery, inherently introducing selection bias. 4 , 5 , 6 Every patient who underwent a laparoscopic foregut surgery after August 1st, 2020 by one surgeon, was placed down the foregut SDS discharge protocol regardless of age, comorbidities, type of foregut surgery performed, complexity of case, size of paraesophageal component, or recurrence status. No patients were excluded from the protocol.…”

Section: Discussionmentioning

confidence: 99%

“…Many of these studies discuss the importance of patient selection and illustrate their strict enrollment criteria for same-day surgery consideration, excluding those with underlying comorbidities, recurrent hiatal hernia repairs, or certain features of their pathology (type 3 or 4 hiatal hernias for example). 4 , 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

A fast tract to foregut surgery: Pandemic-driven protocol development

Zambito

Fritz²,

Banks-Venegoni³

2023

The American Journal of Surgery

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A trans‐Canadian positive deviance seminar for paraesophageal hernia surgery: Reporting national postoperative outcomes and consensus recommendations

Tankel,

Safieddine,

Malthaner

et al. 2024

World j. surg.

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BackgroundThe incidence of adverse events (AEs) and length of stay (LOS) varies significantly following paraesophageal hernia surgery. We performed a Canadian multicenter positive deviance (PD) seminar to review individual center and national level data and establish holistic perioperative practice recommendations.MethodsA national virtual PD seminar was performed in October 2021. Recent best evidence focusing on AEs and LOS was presented. Subsequently, anonymized center‐level AE and LOS data collected between 01/2017 and 01/2021 from a prospective, web‐based database that tracks postoperative outcomes was presented. The top two performing centers with regards to these metrics were chosen and surgeons from these hospitals discussed elements of their treatment pathways that contributed to these outcomes. Consensus recommendations were then identified with participants independently rating their level of agreement.ResultsTwenty‐eight surgeons form 8 centers took part in the seminar across 5 Canadian provinces. Of the 680 included patients included, Clavien‐Dindo grade I and II/III/IV/V complications occurred in 121/39/12/2 patients (17.8%/5.7%/1.8%/0.3%). Respiratory complications were the most common (effusion 12/680, 1.7% and pneumonia 9/680, 1.3%). Esophageal and gastric perforation occurred in 7 and 4/680, (1.0% and 0.6% respectively). Median LOS varied significantly between institutions (1 day, range 1‐3 vs. 7 days, 3‐8, p < 0.001). A strong level of agreement was achieved for 10/12 of the consensus statements generated.ConclusionPD seminars provide a supportive forum for centers to review best evidence and experience and generate recommendations based on expert opinion. Further research is ongoing to determine if this approach effectively accomplishes this objective.

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Laparoscopic hiatal hernia repair as same day surgery: Feasibility, short-term outcomes and costs

Cited by 9 publications

References 12 publications

Same day discharge does not lead to worse outcomes in patients undergoing uncomplicated laparoscopic foregut surgery

Same day discharge does not lead to worse outcomes in patients undergoing uncomplicated laparoscopic foregut surgery

A fast tract to foregut surgery: Pandemic-driven protocol development

A trans‐Canadian positive deviance seminar for paraesophageal hernia surgery: Reporting national postoperative outcomes and consensus recommendations

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