Day surgery for achalasia cardia: Time for consensus?

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery

Background:

• Laparoscopic Heller's myotomy (LHM) is a primary treatment for esophageal achalasia.
• Traditional LHM often involves a hospital stay exceeding one day.
• This study evaluates LHM as a day case procedure.

Purpose of the Study:

• To assess the safety and feasibility of performing Laparoscopic Heller's myotomy (LHM) as a day case procedure.
• To analyze outcomes of LHM performed as outpatient surgery over a 14-year period.

Main Methods:

• Retrospective review of patients undergoing elective LHM for achalasia (2000-2014).
• Data collected included demographics, interventions, length of stay (LOS), complications, and re-interventions.
• Comparison of outcomes before and after adopting LHM as a day case procedure in 2008.

Main Results:

• 45% of 60 patients (mean age 41) underwent LHM as a day case.
• Day case LHM increased significantly from 7.7% to 73.5% after 2008 (p<0.01).
• No significant differences in complications or re-interventions were noted between day case and inpatient groups.

Conclusions:

• Laparoscopic Heller's myotomy (LHM) is a safe and feasible day case procedure.
• Low complication rates and a small need for endoscopic treatment for recurrence are observed.
• Outpatient LHM is a viable option for achalasia treatment.