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Day-Case Fundoplications: a Coastal DGH's Transition

Emily Hale, Rosemary Lowe, Timothy Platt 
Torbay Hospital, Torquay, United Kingdom


Introduction: Torbay Hospital has a well-established day surgery unit, treating over 9,000 patients a year. Day-case laparoscopic fundoplications (LF) are increasingly common, and equally safe in comparison to inpatient procedures. The purpose of this study was to analyse the difference between day-case and inpatients, to determine reasons for stay, and subsequently facilitate more day-cases in Torbay Hospital.

Methods: This is a retrospective study using electronic records to analyse admission, surgery and 30-days recovery. Patients were identified between 1st January 2020 and 1st April 2023 by searching the following OPCS 4.10 codes in operation notes: G231 – G234, G241 - G243 & G245. This identified 96 procedures, 1 of which was immediately excluded as incorrectly identified.

Results: 19 of 95 procedures were day-cases: accounting for 5% of cases in 2020, 22% in 2021, 19% in 2022 and 83% so far in 2023. All day-cases were elective, whilst 9% of inpatients were emergency, the remainder elective. Indications for day-cases were symptomatic reflux (79%), atypical symptoms (16%) and stricture (5%). Inpatient indications were: symptomatic reflux (39%), gastric volvulus (23%), hiatus hernia (12%), atypical symptoms (7%) and other (19%). Average Hill Classification of hiatus hernia was type one in day-case and type three in inpatients.

Conclusion: The majority of LF at Torbay Hospital have been inpatient, although day-cases are increasing. Successful day-cases were always elective, of less severe hiatus hernias, and more commonly for symptomatic reflux as opposed to other pathology. These indicate a pattern to identify future day-case LF and improve our service.