Day Surgery Procedures

Mr Gamal Eldin Mohammed, President Elect IAAS. E-mail: gamal13 at gmail.com

This list of day surgery procedures will not be comprehensive but will give the reader an indication of what is possible in day surgery. A useful guide is produced by the British Association of Day Surgery – the BADS Directory of Procedures.( http://www.daysurgeryuk.net/en/shop/publications/)(external link) This lists over 190 procedures across 10 specialties and provides indicative rates that can be achieved as a day case and short stay in ideal circumstances.

Surgery of adenoids and tonsillectomy - especially in children - is one of the most frequent procedures suitable for day surgery. In some countries inpatient tonsillectomy for adults is advised due to the possibility of haemorrhage, however it should be noted that many countries have been performing these as day cases for many years without problems. However, there is a great difference in patients’ appraisal of day surgery and in social circumstances that may influence the local decision to provide this service.
Ear Surgery:
Procedures with a trans-meatal approach such as placement of grommets or myringoplasty are generally performed on a day basis. Even procedures linked previously to a need for post-operative bed rest such as procedures with a transmastoidal approach are being performed as a day case but once again this is dependent of local circumstances.
Almost all nasal procedures (endoscopic sinus surgery and nose reconstruction) can be performed on an ambulatory basis.

General important recommendations for the operative techniques are:
• no unnecessary tissue traction;
• no unnecessary tissue tension;
• minimally invasive procedures;
• minimal ischaemia;
• complete haemostasis;
• no unnecessary manipulation;

Hernia surgery:
The treatment of groin hernias in adults has moved from the classic approach (Bassini operation and it’s modifications) with overnight stay, sutured techniques and general or spinal anaesthesia to a contemporary approach where day case surgery, local anaesthesia with sedation and open mesh techniques (Lichtenstein operation) are common.

Proctological surgery:
Approximately 90% of all anal procedures can be performed on a day surgery basis:
lateral internal sphincterotomy for anal fissures, fistulectomy.
The excision of one or two haemorrhoids, the application of HAL haemorrhoidal artery ligation for piles, haemorrhoidectomy using the Longo technique for the treatment of III and IV grade haemorrhoids,
Periproctal abscess incisions
Proctological procedures for overnight stay (pain relief and wound control):
high fistulas, surgical excision for grade IV haemorrhoids (Eisenhammer operation)
Attention: packing of the anal canal should be avoided as this can lead to urinary retention.

laparoscopic cholecystectomy (LC)
Indication: symptomatic gallbladder stones
acute cholecystitis
choledocholithiasis (confirmed or suspected)
need for major surgical procedures (suspected conversion)
ASA III (except specified cases)
The patient can be discharged home on the same day if all the regular criteria for discharge are fulfilled. It is advisable to perform in centres where the 23 hour hospital stay is provided, to avoid re-admissions.

Thyroid surgery:
Hemi-thyroidectomy for nodules with a risk of carcinoma can be performed as a day surgery case. Haematoma formation is the only life threatening complication, thus at least 6 hours of post-operative recovery time is required.

Benign lesions: removal of cysts, fibroadenomas, biopsies of palpable/non-palpable lesions, duct excision, correction of gynaecomastia
Malignant lesions: operations on day surgery basis for breast cancer are increasing due to the advent of sentinel lymph node biopsy replacing axillary lymph node dissection for primary breast cancer.

Common gynaecological procedures suitable for day care are:
Diagnostic hysteroscopy, operative hysteroscopy for lesions protruding into the uterine cavity (fibroids), endometrial ablation by hysteroscopy and resectoscope
uterine fibroid embolization using angiography, female sterilisation, diagnostic laparoscopy,
Operative laparoscopy:
extremely large uterine
adnexal pathology (ovarian cysts) and suspected malignancy
ectopic pregnancy, removal of small and benign cysts of the ovary, hysterectomy, myomectomy and prolapse surgery

Cataract surgery: the most frequently performed day surgery procedure. It is generally performed with topical or local anaesthesia.
oculoplastic surgery, squint surgery, glaucoma, dacryo-cysto-rhinostomia, refractive surgery

Almost 90% of all oral and maxillofacial surgery is performed under local anaesthesia and as a day-case procedure:
extraction of carious teeth in children, removal of impacted teeth, surgical exposure of impacted canines
General anaesthesia can be undertaken in the following day-case procedures:
cyst enucleation of large dentigenous cysts, follicular cysts or keratocysts, marsupialisation of mucous retention cysts in the floor of mouth, excision of the sublingual salivary gland
auto-transplantation of premolars and molars, dental implantology

knee arthroscopy (diagnostic)
arthroscopic treatment of minor lesions (meniscus lesions, extraction of free cartilage bodies, debridement of small cartilaginous lesions
arthroscopic removal of osteosynthesis material
arthroscopic anterior cruciate ligament reconstruction
arthroscopy and examination under general anaesthesia
arthroscopic and mini-open acromioplasty
resection of the lateral part of the clavicle
arthroscopic joint stabilization (e.g. Bankart repair)
arthroscopy and examination under general anaesthesia
arthroscopic treatment of minor lesions
extensor tendon release for treatment of tennis elbow
ulnar nerve transposition
removal of screws and plates and/or cerclages
Wrist/hand (95% day-case surgery under local anaesthesia)
arthroscopic treatment of minor lesions (e.g. free cartilage bodies, synovial biopsy)
carpal tunnel release
arthroplasty of CMC I joint for osteoarthritis
finger joint surgery for rheumatoid arthritis
Dupuytren’s contracture surgery
hallux valgus surgery
resection arthroplasty or arthrodesis for hammer toe deformities
arthroscopic treatment of minor lesions (e.g. free cartilage bodies, synovial biopsy
ligament reconstruction (lateral or syndesmosis)
removal of osteosynthesis material
removal of osteosynthesis material
microdiscectomy for the treatment of a herniated intervertebral disc
removal of osteosynthesis material

Children shall be admitted to hospital only if the care they require cannot be equally well provided at home or on a day basis. In day surgery the standards of medical, nursing and psychological and care should be comparable to those for inpatients.
Common paediatric surgical procedures:
inguinal hernia and hydrocoele, umbilical hernia, orchidopexy, circumcision, skin lesions
dermoid cysts.

Wrist/Hand surgery:
the same procedures in orthopaedics are performed by plastic surgeons
Cosmetic surgery:
blepharoplasty , breast augmentation, face lift, abdominoplasty with and without liposuction (with drains to be removed next morning), reconstruction operations (Z-plasty, V-Y plasty)

General urological procedures:
Vasectomy, hydrocelectomy, varicocelectomy, vasectomy reversal, circumcision
Minimally invasive procedures
transurethral resection of bladder tumours, ureteroscopic interventions for ureteric stones
ESWL for stone

The most frequent procedure is the operations for varicose vein (surgical, endovenous obliteration by radiofrequency, laser)
Minimally invasive procedures
subfacial endoscopic division (SEPS) for resection of incompetent perforating veins
thoracic sympathectomy (treatment of hyperhidrosis or Raynaud’s disease)
endovascular procedures like carotid artery stenting.

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