scholarly journals "One step procedure" local anaesthesia for inguinal hernia repair in ambulatory surgery conditions: District general hospital experience

2012 ◽  
Vol 59 (1) ◽  
pp. 87-93 ◽  
Author(s):  
Dejan Dabic ◽  
Vladan Perunicic ◽  
Biljana Maric
Keyword(s):  
Inguinal Hernia ◽  
Local Anaesthesia ◽  
Ambulatory Surgery ◽  
Operating Time ◽  
District General Hospital ◽  
Outpatient Basis ◽  
Lichtenstein Technique ◽  
Step Procedure ◽  
One Step ◽  
The Mean

Ambulatory surgery refers to hospitalization that does not exceed 24 hours, during which a surgical procedure is performed. Inguinal hernia repairs done under local anaesthesia on an outpatient basis are no longer performed exclusively in specialized hernia centers. They are becoming widely accepted by surgeons working in district hospitals, which was significantly contributed to by the publication of the EHS Guidelines on the Treatment of Inguinal Hernia. OBJECTIVE: The objective of this retrospective study is to show local anaesthesia practicability for inguinal hernia repairs through "one-step procedure", being a one-day procedure used in District General Hospital. METHODS: From January 2006 to June 2011, 460 elective surgery procedures were performed on 428 patients with inguinal hernia (396 with unilateral and 32 with bilateral inguinal hernia), using Lichtenstein technique, UHS/PHS, plug repair, and Shouldice technique. All the proceduress were performed under local anaesthesia by the same surgeon using "one-step procedure" in ambulatory surgery. The following anaesthetics were used: Lidocaine for intradermal and subcutaneous anaesthesia as well as Bupivacaine/Levobupivacaine for subfascial anaesthesia. RESULTS: From January 2006 to June 2011, 460 surgical procedures were performed on 428 patients with inguinal hernia (396 with unilateral and 32 with bilateral inguinal hernia). The mean age was 58.2 yrs (20-84). All the patients were in the ASA I - III group. In unilateral hernias, the mean operating time using Lichtenstein technique was 38mins (28-56), using PHS/UHS 28mins (22-40), with plug 33mins (27- 39) and using Shouldice technique 43mins (32-53). In bilateral hernias, the mean operating time using Lichtenstein technique was 71mis (56-87), and using PHS /UHS 56mins (49-64). The mean hospital stay was 2.9hrs (2-6). The mean distance of residence from the hospital was 23km (1-150). During the course of the surgery, 15 patients (3.5%) had problems such as pain, bradycardia, hypotension, or perspiration. The complications during the mean follow-up of 31 months (1-60) was: 1.4% (6 patients) - a hematoma, 1.87% (8 patients) - seroma, 0.47% (2 patients) - wound infection, 0.23% (1 patient) - chronic pain, and 0.47% (2 patients) - recurrence. Revision due to active bleeding was conducted in two patients (0.47%), after using PHS and Lichtenstein techniques. These were the only patients who were rehospitalized due to complications. CONCLUSION: In hernia repairs on an outpatient basis, "one-step procedure" in local anaesthetic administration is reliable, easy, safe, effective, and the type of the surgical technique is not a determining factor. The success rate and treatment outcome depend on the surgical technique and the surgeon?s experience in using local anaesthesia in ambulatory surgery.

scholarly journals Surgical audit of inguinal hernia surgery under local anaesthesia at a district hospital set up in central India

2019 ◽  
Vol 6 (6) ◽  
pp. 1949
Author(s):  
Anurag Jain ◽  
Rajiv Jain ◽  
Hariom Gupta
Keyword(s):  
Inguinal Hernia ◽  
Local Anaesthesia ◽  
District Hospital ◽  
Recovery Period ◽  
Operating Time ◽  
Routine Practice ◽  
Hernia Surgery ◽  
Inguinal Hernia Surgery ◽  
The Mean ◽  
Set Up

Background: This article outlines the results of audit for feasibility and reliability of use of local anaesthesia as a routine practice in inguinal hernia surgery in an Indian district hospital setup. Through this prospective study an effort have been made to analyse practicability of local anaesthesia for inguinal hernia surgery in terms of cost effectiveness, minimizing recovery period, and reducing routine case load on hospitals with a goal to provide health for all, in a set up where patient load outnumber resources both in expertise and facilities.Methods: A prospective analysis and auditing of 120 patients with unilateral inguinal hernia who underwent inguinal hernia surgery by Lichtenstein tension free mesh repair under local anaesthesia at Sehore district hospital during the study period was done. The primary outcomes of the study were analysed on grounds of cost benefit, patient satisfaction levels, complications such as infection, haematoma, chronic pain, and recurrence.Results: The mean age of patients in present study was 44.23 years (20-76 years). The mean operating time was 70 minutes (40-90). The mean post operative room stay was 3.3 hours (2-6 hours). Intraoperatively 30 patients (25%) had problems such as pain, bradycardia/tachycardia, hypotension, perspiration. Recurrance was observed in 1 patient (0.83%) during the mean follow-up of 3.6 months (1-6 months).Conclusions: In hernia repairs local anaesthetic is reliable, easy, safe and cost effective technique and its use can dramatically reduce waiting period for operation in planned surgeries.

Dorsal Adipofascial Turn-Ovesr Flap for Fingertip Amputations

1999 ◽  
Vol 24 (5) ◽  
pp. 525-530 ◽  
Author(s):  
R. E. ÜNLÜ ◽  
A. S. MENGI ◽  
U. KOÇER ◽  
Ö. SENSÖZ
Keyword(s):  
Pedicled Flap ◽  
Split Thickness Skin Graft ◽  
Early Recovery ◽  
Step Procedure ◽  
Thickness Skin ◽  
Exposed Bone ◽  
One Step ◽  
The Mean ◽  
Turn Over

We designed a dorsal adipofascial pedicled flap to cover amputations of the tip of the same digit. This flap includes all the adipofascial tissues from the dermis to the paratenon of the extensor tendons. After elevation of the skin, the adipofascial tissues are raised as a flap and turned over to resurface the exposed bone or joint and then covered with a split thickness skin graft. Ten digital amputations between the distal phalanx proximal to the nail matrix and the mid portion of the middle phalanx were successfully resurfaced with dorsal adipofascial turn-over flaps. All flaps survived completely and the mean follow-up was 11 months. This one-step procedure would seem to be a relatively simple way of achieving early recovery because it does not require the use of distant flaps immobilization of adjacent digits, or homodigital flaps that might jeopardize an already injured finger.

scholarly journals 231 Colecistectomias Laparoscópicas em Ambulatório: Que Resultados?

2013 ◽  
Vol 26 (5) ◽  
pp. 564
Author(s):  
André Goulart ◽  
Margarida Delgado ◽  
Maria Conceição Antunes ◽  
João Braga dos Anjos
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Ambulatory Surgery ◽  
Standard Procedure ◽  
Outpatient Basis ◽  
Readmission Rates ◽  
Overnight Stay ◽  
Stay Time ◽  
Safe Technique ◽  
The Mean ◽  
Mean Time

Introduction: Laparoscopic cholecystectomy is the gold standard procedure for the treatment of lithiasic gallblader pathology and acute cholecystitis. Whether or not it should be done as ambulatory surgery is still being discussed. The present study aims to analyze the quality and safety of laparoscopic cholecystectomy conducted by the Ambulatory Unit of Hospital de Braga and compare the results with those from other European surgical centers performing LC as ambulatory surgery.Material and Methods: Observational prospective study of patients submitted to laparoscopic cholecystectomy in ambulatory surgery during a period of 26 months. Data regarding patients’ demography, peri- and postoperative complications, surgical time, time in recovery room, and readmission rates was collected.Results: A total of 231 patients were subjected to Laparoscopic cholecystectomy in the ambulatory unit with overnight stay (time to discharge less than 24 hours). Three patients presented with intra-operative complications, which needed conversion to laparotomy, and four patients were admitted after surgery. The mean time for the procedure was 58 minutes and the mean time for recovery was 19h19 minutes. Postoperative morbidity was 7.8% with 2 nonscheduled admission having occurred.Discussion: One of the controversies regarding laparoscopic cholecystectomy as an outpatient procedure is the need for overnight hospital surveillance. In our unit, we have started LC on an outpatient basis with an overnight stay. Using this protocol, over the past two years, we have operated 231 patients and our results show that this is a completely safe technique.Conclusions: Data from the study suggests that LC is a safe technique when performed in ambulatory practice, having similar results to other european surgical centers.

scholarly journals Total extraperitoneal approach in large inguino-scrotal hernias: an institutional approach

2016 ◽  
Vol 18 (3) ◽  
pp. 51 ◽  
Author(s):  
Tuhin Shah ◽  
S Shah ◽  
BR Joshi ◽  
RJ Karkee ◽  
RK Gupta
Keyword(s):  
Inguinal Hernia ◽  
Operating Time ◽  
Operation Time ◽  
Hernia Surgery ◽  
Recurrence Rates ◽  
Hernia Sac ◽  
Tep Repair ◽  
Inguinal Hernia Surgery ◽  
Total Extraperitoneal ◽  
The Mean

Introduction: Since 2 decades laparoscopichernia repair has gained key role in uncomplicated inguinal hernia surgery with advantages showed by several trials and guidelines. However, its role in complicated inguinal hernia such as incarcerated, obstructed and inguino-scrotal is debatable. Cases of large inguino-scrotal raises objection to laparoscopic procedure because of anticipated problems and complications in dissecting extended hernia sac even though posterior approach is advocated as repair of choice for complicated cases. Here, we reviewed our series of patients undergoing TEP in a limited time frame.Method: Between March 2013 and June 2014, 50 consecutive patients underwent TEP repair for inguinoscrotal hernia. Patient demographics, hernia characteristics, operating time, surgical technique, conversion rate, intraoperative, postoperative complications and recurrence was recorded and analyzed using MS Excel.Results: 50 patients were recorded, 26 had unilateral and 24 had bilateral hernias. Mean age was 52 (22-72) years. The mean operation time was 70 (50-140) min. Bilateral repairs took 45% (18 min) longer than for unilateral repairs (52 + 12 min). Two (12.5%) patients required combined open surgery to transect the incarcerated omentum. There was no mortality. Morbidity was limited to asymptomatic seroma formation in 2 (12.5%) patients; 1 patient of combined open-TEP approach had wound infection, both treated conservatively. Mean follow up was 6.3 months; we recorded 2 recurrences (12.5%). The mean length of hospital stay was 1.8 days.Conclusion: We conclude that TEP can be safely employed for complicated inguinal hernias repair. Surgical experience in mandatory with tailored technique to reduce morbidity and achieve good clinical outcome with acceptable recurrence rates.

scholarly journals Feasibility of laparoscopic inguinal hernia repair (TEP) in rural centre in India

2017 ◽  
Vol 4 (7) ◽  
pp. 2336
Author(s):  
Prashant Sawarkar ◽  
Ranjana Zade ◽  
Suchine Dhamanaskar ◽  
Bhupendra Gathe ◽  
Pradip Sawardekar ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Return To Work ◽  
Inguinal Hernia Repair ◽  
Gold Standard ◽  
Lichtenstein Technique ◽  
Hernia Surgery ◽  
Tep Repair ◽  
The Mean ◽  
Laparoscopic Tep

Background: Inguinal hernia repair is one of the most frequently performed operations in general surgery worldwide. Routinely used gold standard Lichtenstein technique gives a long scar and more post-operative pain. TEP has demonstrated favourable short-term results, with regards to reduced postoperative stay, pain and earlier return to physical activity in comparison with open mesh repairs.Methods: This study was prospective observational study in which 75 patients were included for TEP repair and followed for the outcome measured as the time taken for operation, incidence of intra operative and post-operative complications, severity of pain at post-operative day 1, 1 week, 1 month and 6 months after operation, return to work and cost effectiveness of inguinal hernia repair.Results: We have enrolled the 75 patients from 16 to 80 years out of which 34 (45.3%) patients were from age group 50 to 70 years.  47 (62.7%) patients operated on right side and 58 (77.4%) were operated for indirect hernia. Mean time taken for TEP was 81.5 minutes with minimum of 45 minutes and maximum of 135 minutes. There was single most complications of Pneumoperitoneum in 24 (32.0%) which was benign and managed conservatively. Other complications include bleeding in 4 (5.3%) and vas injury in one (1.3%). the mean duration of time taken for return to work was 11 days. The mean cost of TEP was Rs. 5932 with minimum of Rs. 4327 and maximum of Rs. 7742.Conclusions: The laparoscopic (TEP) repair is well established surgery for primary hernia repair and the other open tension free Lichtenstein technique is still regarded as a gold standard for inguinal hernia repair. The laparoscopic hernia surgery attempting similar claims underwent controversies with conflicting results. Laparoscopic (TEP) inguinal hernia repair gives greater patient’s satisfaction and better cosmetic results than open (Lichtenstein) repair.

scholarly journals Penile prosthesis surgery in out-patient setting: Effectiveness and costs in the “spending review” era

2014 ◽  
Vol 86 (3) ◽  
pp. 161 ◽  
Author(s):  
Nicola Mondaini ◽  
Enrico Sarti ◽  
Gianluca Giubilei ◽  
Andrea Gavazzi ◽  
Antonio Costanzi ◽  
...  
Keyword(s):  
Ambulatory Surgery ◽  
Operating Time ◽  
Penile Prosthesis ◽  
Day Surgery ◽  
Outpatient Setting ◽  
Outpatient Group ◽  
Penile Implant ◽  
Secondary Procedures ◽  
The Mean ◽  
Prosthetic Surgery

Introduction: Penile implant patients are required to remain in the hospital after the operation for monitoring, antibiotic and analgesia administration. Cost containment, however, has resulted in the increased use of ambulatory surgery settings for many surgical procedures. Few studies have studied the feasibility of performing penile prosthesis insertion in an outpatient setting. The results are controversial and nowadays, in the most of centers that deal with prosthetic surgery, patients are still hospitalized. Aim: The aim of our investigation was to compare the feasibility of the performance as well as the complication profiles of penile implant surgery performed in an in-patient and an outpatient setting at a single center by a single surgeon. Methods: From January 2009 to June 2014, 50 patients of the same uro-andrological unit underwent penile prosthesis implantation performed by a single surgeon (N.M.). Twenty implantations were performed in an ambulatory day surgery setting. Main outcome measures: Effectiveness and costs of outpatient setting versus the in-patient setting of the penile prosthesis surgery. Results: There were some differences between the two groups in the intra-operative parameters, such as, operating time. Time lost from work was similar in both groups approximating 14 days. The mean number of analgesic pills ingested by the patients post-operatively was similar in both groups, averaging just under 25 pills per patient. There weren’t post-operative complications in the outpatient group. Cost were 17% less in outpatient clinic. Conclusions: The outpatient setting for this surgery is safe and effective even in patients with comorbidities or in case of secondary procedures. Costs are reduced by 17%.

Uncomplicated adult inguinal hernia repair under local anaesthesia and spinal anaesthesia

2020 ◽  
Vol 11 (3) ◽  
pp. 3212-3221
Author(s):  
Naniwadekar R G
Keyword(s):  
Inguinal Hernia ◽  
Hospital Stay ◽  
Spinal Anaesthesia ◽  
Local Anaesthesia ◽  
Control Group ◽  
Early Ambulation ◽  
Inguinal Hernias ◽  
Hernia Inguinal ◽  
The Subject ◽  
Prolonged Hospital

Multiple researchers have given numerous guidelines in the clinical management of this disorder in the late nineteenth and twentieth centuries, after comprehensive works on the subject. As a result, a very wide variety of surgical procedures are now available to the surgeon to suit the requirement. There have been numerous advances in the management of inguinal hernia. Inguinal hernias can conveniently be repaired under all kinds of anaesthesia, namely general, spinal and local. Whereas the general anaesthesia requires the services of an experienced anaesthetist and new devices and spinal anaesthesia requires postoperative impairment while local anaesthesia is safe to prescribe, easy and efficient and does not cause postoperative complications. This work consisted of a study group of twenty-five adult patients of uncomplicated inguinal hernias, who after repair of hernias, which after repair of hernias were allowed early ambulation and had a short hospital, stay of one day post operatively. The second control group consisted of similar twenty-five patients who are subjected to conventional delayed ambulation and prolonged hospital stay. The results of repair in the two groups were compared; the available literature on the subject was reviewed. The implementation of ”shortstay surgery” not only relieves the waiting list in hospitals but also offers an economic boost and provides the patient with some social advantages.

Advantages and limitations of the endoscopic tympanoscopy a prospective study

2020 ◽  
Vol 1 (1) ◽  
pp. 012-017
Author(s):  
Najib Zouhair ◽  
Anass Chaouki ◽  
Amine M’khatri ◽  
Youssef Oukessou ◽  
Sami Rouadi ◽  
...  
Keyword(s):  
Middle Ear ◽  
Operating Time ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Invasive Approach ◽  
Intraoperative Bleeding ◽  
Advantages And Disadvantages ◽  
Early Return ◽  
The Mean ◽  
Endoscopic Tympanoplasty

Tympanoplasty is one of the most performed procedures in ENT. The aggressiveness of its microscopic approach has led otologists to adopt the endoscopic approach as a less invasive alternative. The purpose of this work is to appreciate the advantages and disadvantages of this surgical technique. We conducted a prospective descriptive cross-sectional study on 20 interventions within the ENT department of August the 20th 1953 Hospital of Casablanca from April 2019 to June 2019. The average age of operated patients was 36.3 years. Perforations were unilateral in (71%) of the cases with a predominance of the anterior (29%) and subtotal (36%) locations. The tympanoplasties were performed by 3 different senior otologic surgeons, and were left in (57%). The mean operating time was (59.5 min) and the mean anesthesia duration was 75.1 min. Intraoperative vision allowed us to fully visualize the margins of all perforations (100%) and anatomical structures of the middle ear in almost all interventions. The first procedures carried out were filled with difficulties whose management of intraoperative bleeding was the main one in (42.8%) of the cases. (57%) procedures were described as easy. No complication was detected intraoperatively or immediately postoperatively. Endoscopic tympanoplasty has several advantages, including: Minimally invasive approach to the middle ear; panoramic perioperative vision; Gain of operating time; decrease in the duration of anesthesia; Valuable educational tool; postoperative comfort; Decrease in hospital stay and early return to daily activities; Better aesthetic rendering; cost and transportability. However, we also note a number of disadvantages of endoscopic tympanoplasty, particularly: performing the procedure with one hand; difficulty passing through the EAC; 2D vision that alters the perception of depth; management of intraoperative bleeding; fogging; learning curve.

LAPAROSCOPIC TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR TREATMENT INGUINAL HERNIA DISEASE

2018 ◽  
Vol 8 (4) ◽  
pp. 76-80
Author(s):  
Thao Nguyen Minh ◽  
Vu Pham Anh ◽  
Tri Nguyen Huu ◽  
Phu Nguyen Doan Van ◽  
Phuc Nguyen Thanh ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Operative Time ◽  
Bilateral Hernia ◽  
Repair Method ◽  
Tapp Repair ◽  
Post Operation ◽  
Average Operative Time ◽  
The Mean

Background: Inguinal hernia is one of the commonest surgical diseases and there are many different techniques applied. The laparoscopic trans-abdominal pre-peritoneal (TAPP) repair allows a better view of the inguinal anatomy, evaluation of opposite side and resolve combined peritoneal diseases as well. Patient and method: The study included 60 cases with inguinal hernia that have been treated by laparoscopic transabdominal pre-peritoneal (TAPP) repair. Method: Description, prospective follow-up. Result: The mean age was 58±18.2. 96.7% were males. The average operative time was 45.6±15.1 minutes for one side hernia, 73±25.2 minutes for bilateral hernia. 02 cases have been post-operation inguinal seroma complication (3.3%), 02 cases with hydrocele (3.3%), 01 case with abdominal seroma (1.7%). 04 cases (6.7%) opposite inguinal hernia were detected and 05 cases (8.3%) with combined diseases were resolved. Duration of post-operative stay was 3.9±1.1 days. Conclusion: TAPP is a safe and feasible procedure, allows evaluation of opposite side and resolve combined peritoneal diseases.

EARLY RESULTS OF INGUINAL HERNIA REPAIR BY THE “MESH PLUG” TECHNIQUE

2012 ◽  
pp. 43-51
Author(s):  
Doan Van Phu Nguyen ◽  
Loc Le ◽  
Van Lieu Nguyen
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Operating Time ◽  
Life Assessment ◽  
Medium Size ◽  
Mesh Plug ◽  
Postoperative Rehabilitation ◽  
Early Return ◽  
Early Results ◽  
Average Size

Background: In 1989, Lichtenstein I. L., Shulman A. G., Amid P. K., and Montlor M. M. presented an idea of using Mesh Plug to repair the defect inguinal canal. The new technique quickly became accepted by surgeons all over the world for several reasons: faster overall rehabilitation, less postoperative pain, less complication, shorter stay in the hospital and early return to normal activities and work. Materials and method: From Dec 2011 to July 2012, 42 patients with inguinal hernia were surgically treated with 48 Mesh Plugs applied at the Surgery Unit of Hue University of Medicine and Pharmacy. Result: The patients’ average age was 49.12±21.17. There were 25 patients over 40 years old, accounting for 59,5%, and 39 of the group were males, accounting for 92.8%. 10 cases were direct hernia, accounting for 20.8%, and 38 cases were indirect hernia accounting for 79.2%. Based on Nyhus’s classification, there were 33 cases of IIIA and IIIB (68.8%). Based on the position of protrusion, there were 30 cases of right inguinal hernia (62.5%), 18 cases of left inguinal hernia (37.5%), and 6 cases of hernia on both sides. The average size of the deep ring is 2.16±1.64cm. 24 cases used Mesh Plug of medium size (54.5%). The mean operating time was 35.75 minutes. The time of staying in the hospital was 3.52±1.14 days. Quality of life assessment after the surgery showed 46 very good and good cases 95.8% and 2 cases (4.2%) with satisfactory result. No case of bad outcome was recorded. Conclusion: Surgical treatment of inguinal hernia by the Mesh Plug technique is really effective, safe with faster postoperative rehabilitation, less postoperative pain, less complications, shorter hospital stay and early return to normal activities and work.

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