Is it Time to Embark on Laparoscopic Daycare Surgery in Resource-Limited Settings? Perspectives from a Series of Laparoscopic Heller’s Myotomy and Fundoplication for Achalasia Cardia

Abstract

Background: In developing countries, delivering advanced surgical procedures presents a unique array of challenges
and opportunities, including the potential to address the escalating demand for such procedures in resource-constrained
settings. Based on insights gleaned from a case series, we highlight the potential of incorporating daycare practices for
advanced laparoscopic surgeries in Lower- and Middle-Income Countries (LMICs).
Case Presentations: We report a case series of randomly selected patients who underwent laparoscopic Heller’s
myotomy and fundoplication for achalasia cardia at Muhimbili National Hospital in Tanzania. We observed an uneventful
postoperative in-hospital course marked by significant improvement within 24 hours following surgery. However, all
cases had a relatively extended hospital stay; likely stemming from healthcare provider-, patient-, and facility-related
factors.
Conclusion: Given the patient-centered, economic, operational efficiency, and resource utilization advantages associated
with daycare laparoscopic surgery, adopting this method may prove appropriate for LMICs. Therefore, collaborative
efforts from stakeholders are necessary for the integration of this practice into the healthcare systems of developing
economies.