English summary: LAPAROSCOPIC FUNDOPLICATION AS A DAY-CASE PROCEDURE

Background: Day-case laparoscopic fundoplication for gastro-oesophageal reflux disease was started in March 2003 at the Vaasa Central Hospital as a prospective study with the aim of assessing safety, acceptability and patient satisfaction.

Methods: Inclusion criteria were American Society of Anaesthesiologists grade I-II, a body mass index below 35, and adult company at home (less than 50 km to travel) or at the patient hotel (more than 50 km to travel). Patients were given general anaesthesia with propophol-infusion, fentanyl, rocuronium and sevoflurane with air+oxygen. All patients received parenteral propacetamol, NSAID, local anaesthetics and metoclopramide as pre-emptive analgesia before awakening. A total 360-degree floppy Nissen fundoplication was performed on all patients.

Results: Twenty-eight patients were included. There was one conversion to open surgery. All the other patients were discharged as planned and there were no readmissions. No intra- or postoperative complications occurred. Postoperative pain, nausea, fatigue and dysphagia were moderate. When interviewed the next morning, three patients reported they would rather have stayed overnight at the hospital. However, all patients were ready for a similar procedure as day-case surgery again, if offered. At follow-up, 26 patients were satisfied with the day-case treatment and one patient was indifferent. All patients would recommend this operation as day-case surgery to a family member or friend.

Conclusion: Laparoscopic day-case surgery for gastro-oesophageal reflux disease appears to be safe and well tolerated by the patients.