Page 4 - Laparoscopic Journal - WJOLS

Kaundinya Kiran Bharatam
• Co-existent conditions like peptic ulcer disease or 3. Postoperative complications:
cholelithiasis as the causes for dyspepsia along with • Postoperative dysphagia/odynophagia 0
GERD symptoms • Postoperative bleeding 0
• Patient unfit for surgery. • Postoperative respiratory complications 0
• Postoperative wound complications 0
oBSERVATionS • Postoperative complications unrelated
to above 0
Following were the observations seen in the patient
group: • Readmission 0
• Total no. of cases—25 • Postoperative gas bloating symptoms 0
• Duration—2012 to 2015 4. Follow-up relief in symptoms—100%
• Study—retrospective analysis Our observations indicate that with a proper selection
• Center—single center and same team of surgeon, criterion, laparoscopic Nissen-Rossetti fundoplication can
co-surgeon, and anesthetist be offered as antireflux therapy to the patient as a day
• Age of patients—from 25 to 65 years care procedure.
• Sex of patients—predominantly females. Laparoscopic Nissen-Rossetti fundoplication does not
The patients once diagnosed were asked to undergo involve dividing the short gastric vessels, and thus allows
anesthesia fitness evaluation prior to surgery. Once fit for a faster surgery with minimal bleeding. The fundic wrap
surgery, the patients were asked to come to the hospital is fashioned in a careful manner after creating a wide
early in the morning of the surgery on an empty stomach retroesophageal tunnel and ensuring that the wrap is
since the previous night after a short meal. The surgery not tight at all. Postoperative dysphagia, bleeding, gas
was done within 2 to 3 hours of the admission. bloating, etc. are usually not encountered but the patient
The choice of procedure was laparoscopic Nissen- is kept on a liquid diet for 3 days to allow the inflamma-
rossetti fundoplication under general anesthesia and tion to subside along the wrap and prevent any discom-
the procedure duration varied from 60 to 90 minutes. fort to swallowing. Pain was the main challenge in the
Postoperatively the patient was given pain relief by early discharge and was assessed using the pain score
transversus abdominis plane (TAP) block intraopera- and it was found that patients usually were comfortable
tive with sensorcaine (0.25%) and by nonsteroidal anti- postoperatively with adequate local infiltration in the
inflammatory drugs (NSAIDs) like diclofenac sodium muscle planes during surgery at the port sites and also
8,9
postoperative on a si omni sit (SOS) basis. A pain score with one or two doses of NSAIDs like diclofenac sodium
was chosen to subjectively assess the postoperative pain or paracetamol. None of the patients required readmis-
as a choice for the analgesia (> 4). Postoperatively after sion or felt the need to stay longer.
6 hours of surgery liquids were initiated to the patient and DiSCUSSion
they were given liberally after an hour of tolerating the
same. The patient was discharged for follow-up after A 360º fundoplication is the most common treatment for
having liquids. GERD presently especially for both acid and bile reflux in
Patients on follow-up day 3 were advised semisolid patients who respond poorly to the proton pump inhibi-
food and on day 7 were given soft diet. On day 7, the tors. Even regression of Barrett’s metaplasia after surgery
sutures were removed. Patient was given a choice of has become the interest for physicians to advocate the
discharge in every instance and plan was to avoid dis- procedure. 10
charge if the patient did not feel comfortable going home Few papers have been published regarding the fea-
or if the pain was high. sibility of laparoscopic Nissen fundoplication in day
Our observations during the postoperative period care setting and fewer are double cohort studies in this
were as follows: regard. 11-13
1. Average stay of patient in the hospital—12 to 16 hours Day care fundoplication was taken into consideration
2. Postoperative pain score: and the discharge criteria according to the postanesthesia
• Score 1–4 20 discharge score system were: < 20% deviation of pulse
• Score 5–8 4 and blood pressure compared with preoperative values,
• Score > 8 1 balanced gait without dizziness, pain acceptable and pain
All patients responded to oral NSAIDs if the pain regulated with oral analgesics, no excessive nausea and
14
score was high. vomiting and minimal blood loss. Other quality of life
All the patients were willing for discharge post- assessors were the EQ-5D—a simple questionnaire based
ope ratively. on five dimensions: mobility, self-care, usual activity,
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