Same day discharge for benign laparoscopic hiatal surgery: a feasibility analysis.

Area of Science:

• Minimally Invasive Surgery
• Thoracic Surgery
• Gastrointestinal Surgery

Background:

• Enhanced recovery pathways and minimally invasive techniques are driving the adoption of day-surgery programs.
• Laparoscopic surgery is standard for benign hiatal diseases, but same-day discharge safety for procedures beyond fundoplication needs evaluation.

Purpose of the Study:

• To assess the feasibility and safety of same-day discharge for various laparoscopic hiatal surgeries.
• Included procedures: primary and revisional paraesophageal hernia repairs (PEHR), fundoplication, and Heller myotomy (with or without diverticulectomy).

Main Methods:

• Retrospective cohort study of elective laparoscopic hiatal procedures (2011-2016) at McGill University Health Centre.
• Comparison of planned day-surgery (DAYCASE) versus planned inpatient (INPATIENT) cohorts.
• Outcomes assessed: operative/postoperative results, length of stay, readmission, and emergency room visits.

Main Results:

• 261 patients underwent procedures: PEHR (47.1%), Heller myotomy (36%), fundoplication (16.9%). Revisions in 7.7%.
• Successful same-day discharge in 80/98 (81.6%) planned cases; DAYCASE proportion rose from 12% to 67% by 2016.
• No significant differences in complications, readmission, or ER visits between DAYCASE and INPATIENT cohorts. Female gender, late start, and intra/postoperative complications predicted unplanned admission.

Conclusions:

• Day-case surgery for complex laparoscopic hiatal procedures is feasible.
• A significant proportion of patients can undergo these procedures with same-day discharge safely.
• Outcomes are not compromised by same-day discharge in carefully selected patients.