Chandni Kaushik, MS1, Madison Milhoan, MS1, Anshu Khanna, MPH1, Munish Chawla, MD2, Charles C Miller, PhD1, Farzaneh Banki, MD3. 1McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), 2Memorial Hermann Southeast Esophageal Disease Center, 3McGovern Medical School at the University of Texas Health Science Center at Houston ( UT Health). Memorial Hermann Southeast Esophageal Disease Center.
Introduction: The reported length of stay after Heller myotomy is 1-4 days. The aim was to report the results of Heller myotomy and Dor fundoplication in a single esophageal center and the feasibility of the procedure as same day surgery (SDS).
Methods: Patients who underwent laparoscopic Heller myotomy and Dor fundoplication from 11/20/2009 to 08/17/2017, were included. The procedures were planned as SDS after 04/2015. All were performed by the same anesthesia and surgical team. The 4 steps used to facilitate SDS included 1: Prior to surgery-clear liquid diet for 24 hours. 2: In preoperative holding -antiemetics: dermal patch and IV. 3: In the operating room – intubation in semi upright position, analgesics IV at the time of incision and at the time of extubation, antiemetic and removal of Foley catheter prior to extubation. None had nasogastric tube. 4: In the recovery room- check dressings, start clear liquid diet, verify ability to void, review discharge instructions, including full liquid diet for 2 weeks and lifting restrictions. Patients were seen in the clinic 5-9 days after surgery and were followed by the operating surgeon, using a questionnaire by telephone. Values are median (IQR).
Results: There were 67 patients. Completion Heller (n=7), epiphrenic diverticulum (n=3) were excluded, 57 patients were included. 32M (56%)/ 25F (44%), age 48(35-59). The first 45 were inpatient with LOS of 1 day, the last 12 were planned as SDS. One patient who vomited at the time of intubation was discharged on POD#2 (added to the inpatient list): 11/12 (92%) were SDS. There was no difference between, age, ASA, BMI, duration of symptoms, radiographic staging, number of balloon/Botox injections between 2 groups. The duration of operation was 131min (113-158), inpatient: 139.5 (114-163) vs. SDS: 123 (107-139), p<0.01. There was no transfusion, conversion, leak or readmission.
Questionnaire was obtained in 45/57(79%) at 32 months (12-61), inpatient 36/46(78%), at (25.6-67) vs SDS: 9/11(82%) at 8(4-12). All were satisfied with the operation, 39/45 (87%) were free of preoperative symptoms, 44/45 (98%) could eat as desired, weight-gain: 10(0-15) lbs, use of PPI: 3/45(7%). There was no difference between 2 groups.
Conclusions: Heller myotomy can be planned as same day surgery and successfully performed in majority of patients. The requirements include an experienced surgical team, and a recovery protocol focused on prevention of nausea and adequate pain control in the perioperative period. Clear instructions to the team and patients are essential.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87965
Program Number: P356
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster