Laparoscopic antireflux surgery at an outpatient surgery center

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Abstract
Laparoscopic fundoplication (LF) procedures have been shown to be safe and effective for the control of gastroesophageal reflux disease (GERD). Preliminary reports suggests that LF can be performed safely in an ambulatory surgery center. We report on our extensive experience with outpatient LF. Since May 1995, we have performed laparoscopic antireflux procedures in 557 consecutive patients at a freestanding outpatient surgery center. All patients had esophageal manometrics and esophagogastroduodenoscopy (EGD) within 1 year of their surgical procedure. This series included 16 patients with large paraesophageal hernias (mostly type III) and 22 patients with prior antireflux procedures. Most patients (n=494) underwent Nissen fundoplication. Patients were typically given clear liquids 6 hs postoperatively and discharged home in <23 hs. None of the 557 patients required conversion to an open procedure. There was one de ath 2 weeks postoperatively secondary to myocardial infarction. The overall complication rate was 3.6%. The transfer rate to an inpatient setting was 1.25%. The readmission rate was 1.1%. Two patients (0.4%) were returned to the operating room the same day, one for trochar site bleeding and one for crural disruption secondary to vomiting. The average operative time was 58 mins, and the average operating room time was 101 mins. The results of this large series suggest that the outpatient setting is a safe, cost-effective, and patient-friendly location for the performance of laparoscopic antireflux procedures.