Day-case laparoscopic fundoplication for gastro-oesophageal reflux disease

Background: Based on a series of successful outpatient laparoscopic cholecy stectomies, day-case laparoscopic fundoplication for gastro-oesophageal ref lux disease was introduced in January 1997. The initial results are reporte d. Methods: Inclusion criteria were American Society of Anesthesiologists grad e I-II, living within 30 min travel from the hospital, and adult company at home. Initially only selected patients were offered day-case treatment, bu t later it was adopted as routine. The patients underwent general intraveno us anaesthesia with propofol and remifentanil, and were given ketorolac, pr opacetamol, droperidol and ondansetron as prophylaxis against postoperative pain and nausea. The surgical procedure was Nissen-Rosetti fundoplication or semifundoplication depending on oesophageal manometric results. Results: Forty-five patients were included. Four patients were admitted; 41 were discharged as planned 3-8 h after operation, and five of these patien ts were readmitted. One underwent reoperation for necrosis of the gastric f undus. A further five patients visited the outpatient department without ne ed for admission. At follow-up 31 patients were satisfied with the day-case treatment, five were indifferent, and five were dissatisfied because of pa in. If offered a similar operation in the future, 26 patients would have pr eferred and seven would have accepted day-case treatment, and eight would n ot. Conclusion: Outpatient laparoscopic fundoplication is safe and well tolerat ed by the majority of patients.