Day case laparoscopic incisional hernia repair is feasible, acceptable, and cost effective

• DOI: 10.1007/s00464-005-0777-2
• Publication Date: 2006-11-16T08:57:31Z
• Authors: A. H. Engledow; N. Sengupta; F. Akhras; M. Tutton; S. J. Warren
• Keywords: Adult; Aged, 80 and over; Male; Postoperative Care; Analgesics; Remission, Spontaneous; Middle Aged; Drug Administration Schedule; Anti-Bacterial Agents; Hernia, Abdominal; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Ambulatory Surgical Procedures; Diathermy; Humans; Female; Laparoscopy; Prospective Studies; Hospital Costs; Burns; Aged; Follow-Up Studies

Day case surgery is increasingly performed in the United Kingdom. Laparoscopic techniques have increased the number of conditions suitable for a day surgical approach. Findings have shown that laparoscopic incisional hernia repair (LIHR) is superior to conventional open techniques. This study aimed to show that day case LIHR is safe, produces a good clinical outcome, and is cost effective.Day case laparoscopic repair was performed for 31 consecutive patients (10 men; median age, 67 years; range, 39-80 years). Data were entered prospectively into a database. Patients were discharged within 8 h committed to a 10-day course of oral diclofenac 50 mg three times daily and 2 tablets of codydramol four times daily. Follow-up evaluation was by telephone consultation. Hospital costs for LIHR and open repair were compared.All procedures were completed laparoscopically on a day case basis. Additional unsuspected defects were found in eight cases (25.8%). The median mesh size was 140 cm2 (range, 25-375 cm2), and the median body mass index (BMI) was 28.7 kg/m2 (range, 20-37.1 kg/m2). Operations were performed or supervised by a single consultant surgeon (S.J.W.). Six postoperative seromas resolved spontaneously. Two port-site infections required oral antibiotics, and one diathermy pad burn healed with simple dressings. The median analgesia requirement was 7 days (range, 0-152 days). There were no recurrences during a median follow-up period of 15 months (range, 3-24 months). There was a saving of 616 pounds sterling per procedure.Day case laparoscopic repair of incisional hernias is feasible and safe and has a good clinical outcome. The hospital costs are less than for open techniques.