In January 1997, a team from Oslo, Norway introduced day-case laparoscopic fundoplication for gastro-esophageal reflux disease, based on a series of successful outpatient laparoscopic cholecystectomies.
The trial's inclusion criteria were American Society of Anesthesiologists grade I-II, living within 30 min travel from the hospital, and adult company at home.
Initially only selected patients were offered day-case treatment, but later it was adopted as routine. Forty-five patients were included.
The patients underwent general intravenous anesthesia with propofol and remifentanil, and were given ketorolac, propacetamol, droperidol and ondansetron as prophylaxis against postoperative pain and nausea.
The surgical procedure was Nissen-Rosetti fundoplication or semifundoplication, depending on esophageal manometric results.
Of the 45 patients, 4 were admitted; 41 were discharged as planned 3-8 hours after operation, and five of these patients were readmitted.
One patient underwent re-operation for necrosis of the gastric fundus. A further five patients visited the outpatient department without need for admission.
Reaction at follow-up:
At follow-up, the team found that 31 patients were satisfied with the day-case treatment, five were indifferent, and five were dissatisfied because of pain.
If offered a similar operation in the future, 26 patients would have preferred and seven would have accepted day-case treatment, but eight would not.
Dr. E. Trondsen concluded on behalf of the group, "Outpatient laparoscopic fundoplication is safe and well-tolerated by the majority of patients."