Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK.
Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK.
Int J Surg. 2018 Jun;54(Pt A):82-85. doi: 10.1016/j.ijsu.2018.04.039. Epub 2018 Apr 25.
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.
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.
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)).
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.
腹腔镜抗反流手术已成为对药物治疗有抗药性的有症状胃食管反流病的标准治疗方法。成功的抗反流手术需要安全、微创的手术，以最小的副作用达到症状缓解的效果。本研究旨在评估日间抗反流手术的可行性和安全性，将围手术期和术后结果作为成功的衡量标准。
从 2003 年至 2012 年，我们从医院数据库中收集数据。数据收集包括人口统计学资料、外科医生、入院方式、住院时间和并发症。对所有住院时间超过两晚的患者的电子记录进行独立审查。
723 例患者接受了腹腔镜胃底折叠术（± ＜5cm 的小裂孔疝修补术），日间手术率为 67.1%。这些患者的 30 天再入院率为 2.9%（21/723 例）。9 例患者最初的腹腔镜胃底折叠术失败（定义为症状复发）。3 例患者在最初手术 12 个月内需要再次手术（再次手术率为 0.41%（3/723 例））。
在高容量的专业中心，腹腔镜食管裂孔手术可以作为日间手术安全进行，且具有良好的效果。提高日间胃底折叠术的国家标准是促进良好实践的基础，应该成为未来委托的模式。
