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Day-case laparoscopic ventral rectopexy: An achievable reality.
MedLine Citation:
PMID:  23320615     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIM: Laparoscopic ventral rectopexy (LVR) is a non-resectional technique for selected patients with full thickness rectal prolapse and obstructed defecation syndrome. Despite its challenges, LVR can be performed with relatively minimal patient trauma thus creating the potential for same-day discharge. Our aim was to assess the safety of day-case LVR and identify factors associated with same-day discharge. METHODS: Data were prospectively collected on all patients (n=120) from June 2008 to October 2011. Variables included demographics, peri-operative details and post-operative course. Primary outcome was length of stay and secondary outcome was symptom improvement at the latest outpatient follow-up. Patients discharged the same-day after LVR were compared to those who stayed overnight or longer. RESULTS: Indications included rectocele and internal prolapse (47%), full thickness rectal prolapse (44%) and other (9%). Mean operative time was 97 minutes, same-day discharge occurred with 23% (n=27) and 67% (n=80) were discharged on postoperative day 1. In terms of complications - 89% none, 8% minor and 3% major, including one 24-hour readmission for pain. Logistic regression identified younger age (p=0.054) and private insurance status (p<0.001) as being significantly associated with same-day discharge. Although surgical indication (p<0.001), no prior hysterectomy (p=0.012) and use of biologic mesh (p=0.012) had significant association they were likely confounded by age. CONCLUSION: In selected patients with rectal prolapse or obstructed defecation, same-day discharge after LVR is feasible and safe. Our analysis identified quicker discharge in the private system with younger patients. Nevertheless, in unselected patients 90% were discharged by the first operative day. © 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.
Authors:
Mp Powar; Jw Ogilvie; Arl Stevenson
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-15
Journal Detail:
Title:  Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland     Volume:  -     ISSN:  1463-1318     ISO Abbreviation:  Colorectal Dis     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883611     Medline TA:  Colorectal Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.
Affiliation:
Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
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