[FAST TRACK rehabilitation in patients after laparoscopic repair of hiatal hernia]. / Rezul'taty primeneniia programmy uskorennogo vyzdorovleniia FAST TRACK u patsientov s laparoskopicheskoi korrektsiei gryzhi pishchevodnogo otverstiia diafragmy.

AIM: To assess an effectiveness of FAST TRACK rehabilitation in patients after laparoscopic repair of hiatal hernia. MATERIAL AND METHODS: There were 87 patients with hiatal hernia who underwent laparoscopic Nissen-Rossetti procedure with wrapping only anterior wall of the stomach. FAST TRACK approach was applied in 49 patients, standard protocol - in 38 cases. Effectiveness of FAST TRACK rehabilitation was assessed in this report considering early postoperative morbidity, length of hospital-stay, time of postoperative intestinal paresis, complaints by GSRS questionnaire. CONCLUSION: FAST TRACK rehabilitation is followed by reduced early postoperative morbidity, length of hospital-stay and number of postoperative complaints.

Fast-track giant paraoesophageal hernia repair using a simplified laparoscopic technique.

BACKGROUND AND AIMS: Operation for paraoesophageal hernia may be associated with severe complications, especially when performed as an open technique. Furthermore, it is not settled whether the procedure should be performed in combination with an antireflux procedure. Fast-track rehabilitation programs in other operations have been associated with shortened hospital stay and reduced complications compared with conventional care programs. The aim of the present study was to combine a simplified surgical technique with a fast-track rehabilitation program for repair of giant paraoesophageal hernia. METHODS: During a 2-year period, 21 patients underwent laparoscopic paraoesophageal hernia repair with a fast-track rehabilitation program. We did not use an antireflux procedure or repaired the enlarged hiatus in any of the patients. All patients had the hernia sac dissected and a gastropexy to the anterior abdominal wall. RESULTS: Median operation time was 75 min (range 65-120), and the median postoperative hospital stay was 2 days (1-20), where 10 patients stayed for only 1 day. Two patients received postoperative blood transfusions, and the same 2 patients also developed postoperative pneumonia treated with penicillin. Before operation, 4 patients were treated with proton pump inhibitors for reflux symptoms, but after operation, only 1 patient continued treatment with omeprazol 20 mg daily. At barium x-ray follow-up after 3 months, 3 patients had a partial recurrence of a paraoesophageal hernia, but none of them had any symptoms and therefore did not undergo further treatment. CONCLUSION: Using a fast-track rehabilitation program and a simplified laparoscopic surgical technique, repair of giant paraoesophageal hernias can be performed with a short hospital stay and minimal complications.