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Laparoscopic Hiatal Hernia Repair; making the complex routine over 250 cases

William P Boyan Jr, MD1, Brian Shea, MD1, Jonathan Decker, DO1, Abi James, MD1, Lokesh Lahoti, BS2, Frank Borao, MD, FACS1, Steven Binenbaum, MD, FACS1, Steven Binenbaum, MD, FACS1, Gurdeep Matharoo, MD, FACS1. 1Monmouth Medical Center, 2Drexel University SOM

Introduction: Laparoscopic techniques have made hiatal hernia repair a more popular procedure. Like all surgical fields there is a push towards standardization of the post operative course while maintaining safe practices. Other surgical fields have streamlined recovery processes in an effort to standardize care and minimize costs.  Laparoscopic hiatal hernia repair is a complex procedure, but with experience and a team approach, this operation can become a streamline process.

Methods: A retrospective review was done for over 250 laparoscopic hiatal hernia repairs at a single institution. Aspects of post operative care such hospital floor, nursing ratio utilized, pain medication, diet advancement, use of foley catheters and length of hospital stay were tracked. Statistical analysis was done to compare utilization of resources as years went on along with complications and readmissions.  

Results: A total of 258 hiatal hernias were performed between 2011 and 2017. Improvements were noted in nearly every field over time, including faster foley removal, decreased length of hospital stay, decreased use of patient controlled analgesics (PCAs) and faster advancement of diet.  Furthermore these patients are now treated on a surgical floor rather than the intensive care unit or step down with a higher nurse to patient ratio, decreasing hospital cost. There were no changes in complications, reoperations or readmissions over the course of the study.

Conclusions: Cost, length of stay and so called “advanced recovery pathways” are all the rage in the surgical literature. Anytime a procedure and its post operative course can become less of a “major undertaking” and more routine, the more streamline it becomes. This comes from making a standard protocol that deescalates treatment based on what is actually needed. Nearly every aspect of post operative care was simplified; length of stay and cost to the hospital was decreased while no additional complications or readmissions were accrued. The foundation of a formalized advanced recovery pathway will be implemented from these factors which were studied.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 86515

Program Number: P456

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

60

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