Margaret Jackson, MD1, Farzaneh Banki2. 1McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), 2McGovern 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 a case of laparoscopic Heller myotomy with Dor fundoplication and type III hiatal hernia repair as same day surgery (SDS). The patient is a 57 y old male with 5 year history of progressive symptoms of, dysphagia, heartburn, and weight loss of 20 lbs. Preoperative work up confirmed achalasia and type III hernia.
Methods: Plan for laparoscopic reduction of type III hiatal hernia, primary crural closure, Heller myotomy, and Dor fundoplication as same day surgery. The procedure was performed by consistent 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. No nasogastric tube was needed. 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.
Results: The procedure was performed without complications with the duration of 139 minutes. In the recovery room the labs were normal, CXR showed no effusion or pneumothorax. The patient was tolerating a full liquid diet, the dressing were intact and he was able to void. The discharge instructions were reviewed and he was discharged home. He was seen in the clinic on POD#6. He was doing well, tolerating a full liquid diet. The diet was advanced to soft esophageal diet and as tolerated
Conclusions: Heller myotomy with Dor fundoplication and hiatal hernia repair can be performed as same day surgery. 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: 87842
Program Number: V123
Presentation Session: Friday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo