Benefica chirurgia. A global surgery project focusing on hernia surgery

BackgroundThe aim of international health cooperation projects is to alleviate the deficiencies in the area of health in low resource settings. Hernia surgery is a procedure that is well suited to these missions, due to its low morbidity, the fact that it can be performed on an outpatient basis, and the improvement in quality of life that it provides.ObjectiveTo describe the results of Benefica Chirurgia (BC), a Spanish non-profit humanitarian association in hernia pathology.MethodsFive one-week surgical campaigns were carried out in Ecuador between 2015 and 2019, involving anesthetists, general and pediatric surgeons. Surgical and medical equipment was provided and transported by BC. ASA I/II patients underwent surgery.ResultsSurgery was performed on 240 patients with hernia pathology on 27 days. Sixty-three per cent of patients were male and the mean age was 48.2 years (range: 1–83). Hernia location was inguinal in 113 patients, umbilical in 101, and other in 26. The anesthetic technique used was spinal in 185 patients (77.1%), local plus intravenous sedation in 31 (12.9%), and general in 24 (10%). The surgical technique used was hernioplasty in 191 patients, herniorrhaphy in 31, incisional hernia repair in 15 and herniotomy in three. Surgery was performed on an outpatient basis in 98.4% of cases. Morbidity was 2%. Long-term postoperative evaluation is very complex.ConclusionThese campaigns make a significant contribution to health in low resource settings and provide great personal satisfaction for those involved. Standards achieved in the immediate postoperative period were similar to those obtained at the surgeons’ centers in Europe. However, it is difficult to establish the rates of recurrence and chronic pain.     

快速康复外科理念在成人腹股沟疝日间手术的应用体会

目的探讨快速康复外科理念指导下的成人腹股沟疝日间手术的安全性及有效性。 方法采用前瞻性研究方法,将符合入选条件的67例患者分为试验组与对照组。试验组采用快速康复外科理念指导下的日间手术治疗成人腹股沟疝,麻醉方式为局部浸润麻醉;对照组为住院手术患者,常规采用椎管内麻醉。分析比较2组术后2 h疼痛评分、术后下床活动时间及术后进食或饮水时间、术后并发症发生情况及平均住院费用;记录试验组15 d内非计划再次入院率、日间手术延迟出院率。 结果试验组术后2 h疼痛评分（3.6±1.1）分、术后下床活动时间（3.2±1.1）h、术后进食或饮水时间（2.3±0.9）h及平均住院费用（4060.0±91.3）元与对照组（6.0±1.0）分、（7.2±1.1）h、（7.1±0.9）h、（5635.6±229.0）元比较,差异均有统计学意义（P<0.05）。2组术后并发症发生情况差异无统计学意义（P>0.05）,术后随访4~16个月,均无复发。试验组无15 d内非计划再次入院及日间手术延迟出院患者。 结论快速康复外科理念指导下的成人腹股沟疝日间手术,安全有效。     

儿童腹股沟疝日间手术模式的安全性和有效性

目的探讨儿童腹股沟疝日间手术模式的安全性及可行性。 方法回顾性分析2018年1月至2019年6月山东大学附属济南市中心医院收治的腹股沟疝患儿共158例,按照诊疗模式分为常规手术组患儿80例,日间手术组患儿78例。所有患儿均在全身麻醉下行腹腔镜手术,观察2组手术时间,总住院时间,术后并发症,住院费用、患儿家长及医护的满意度。 结果2组患儿均顺利完成手术,日间手术组总住院时间[（16.27±3.53）h]、住院费用[（7276.09±1599.90）元]较常规手术组[（70.40±13.48）h、（7860.43±1406.66）元]显著偏低,日间手术组医护满意度（非常满意+满意度,91.0%）、患儿家长满意度（非常满意+满意度,97.4%）较常规手术组（78.8%、87.5%）偏高,差异均有统计学意义（P<0.05）;2组手术时间、术后并发症差异无统计学意义（P>0.05）。 结论儿童腹股沟疝日间手术是一种安全有效的手术模式,可提高医护及患儿家属满意度,符合快速康复外科理念。     

腹股沟疝日间手术围手术期个体化护理体会

目的探讨腹股沟疝日间手术围手术期个体化护理措施。 方法2019年9至12月首都医科大学附属北京朝阳医院日间手术室完成359例成人腹股沟疝日间手术,均给予个体化护理。 结果全部患者均顺利出院,术后疼痛视觉模拟评分为2～6分,平均（2.3±0.7）分,术后随访3～6个月,平均（5.5±1.1）个月,无复发、慢性疼痛及异物感,均恢复良好。 结论合理规范的围手术期个体化护理可以提高腹股沟疝日间手术的成功率,减少术后并发症的发生。     

Predicting chronic post-operative pain following laparoscopic inguinal hernia repair

Background  Chronic post-operative pain (CPP) following laparoscopic inguinal hernia repair (LIHR) may cause significant morbidity and be more problematic than recurrence. Determining pre-operative risk may reduce morbidity. Our aim was to determine prevalence of CPP following LIHR and identify risk factors for its development. Methods  Data from patients undergoing LIHR (1996–2004) at one District General Hospital were collected, including demographics, body mass index, pre-operative pain, LIHR type (TEP or TAPP, primary/recurrent, unilateral/bilateral) and post-operative complications including CPP (pain lasting ≥1 year). Results  A total of 881 patients underwent LIHR (1,029 hernias). Of these, 523 (60%) patients completed the questionnaire, and 72/523 (13.8%) patients experienced CPP. Presence of pre-operative pain (P < 0.001), recurrent LIHR (P = 0.021) and age <50 years (P < 0.001) were significantly correlated with CPP. Conclusion  Chronic post-operative pain following LIHR is more prevalent than recurrence. Pre-operative pain, surgery for recurrent inguinal hernias (following anterior repair) and younger age at surgery predict development of CPP. Identification of ‘high-risk’ patients may improve management, reducing morbidity and cost.     

Early complications in tension-free hernioplasty: comparison between ambulatory and short-stay surgery

Summary This is a prospective cohort study of the early results in tension-free hernioplasty in both ambulatory surgery (AS) and short-stay surgery (SS).We recorded data of 609 patients with 707 hernias. 346 patients (57%) were operated on by AS and 253 (43%) as SS. Tension-free hernioplasty was performed in 95% of cases. Regional anesthesia was the most common anesthetic procedure in both groups. Patients of the AS group were younger (AS = 49 years, SS = 62 years) and had fewer associated diseases. The commonest immediate complication was urinary retention in both groups (AS = 9.5%, SS = 10.5%). Hematoma was the most common early complication but there were no differences between groups (AS = 5.2%, SS–7%). Wound infection rate was 2.3 % (AS = 1.4%, SS = 3.2%), but removal of the mesh was not needed in any case. Other complications were sefoma (AS = 2.8, SS = 2.9%), pain (AS = 2.2%, SS = 1.2%), and orchitis (0.3% in both groups). There were low early complication rates in both groups, with better results (not significant) in the AS group. The advantages of ambulatory surgery make this the method of choice in suitable patients.     

新型冠状病毒疫情常态化防控下腹股沟疝日间手术管理和安全性分析

目的探讨在新型冠状病毒感染疫情常态化防控背景下,开展腹股沟疝日间手术的安全性和全流程管理方案。 方法回顾性分析2020年9月至2021年6月在首都医科大学附属北京朝阳医院日间手术中心接受腹股沟疝日间手术患者的临床和随访资料。 结果在多方设计完善的日间手术全流程管理方案下,共完成腹股沟疝日间手术824例,其中开放手术285例,腹腔镜手术539例,手术时间（50.9±22.6）min,术后随访时间12.1~22.2个月,平均16.7个月。术后发生血清肿44例,血肿1例,切口感染2例,复发1例。无新型冠状病毒感染病例发生。 结论严格遵守疫情常态化防控措施并精准实施,可以确保腹股沟疝日间手术在全面防护安全的同时取得良好效果。     

Local anesthesia plus deep sedation for adult inguinal hernia repair in an ambulatory surgery center

Summary Two hundred consecutive adult patients receiving Perfix mesh plugs and onlay mesh grafts for inguinal hernia repairs in an ambulatory surgery unit were studied between January 1996 and October 1997. Xylocaine and Marcaine were used for local anesthesia. Deep sedation was maintained with intravenous Propofol after induction with Versed and Fentanyl. Some patients received Brevital and most were given Toradol to prolong analgesia. Total operating room time averaged 45 minutes. Narcotic use for pain relief averaged 2 days, and the majority were driving their cars in 6 days. Local anesthesia plus intravenous deep sedation has excellent patient acceptance and enables rapid patient recovery from inguinal herniorrhaphy.     

乳腺Mammotome微创旋切系统在日间手术中心的应用分析

目的探讨乳腺微创手术旋切系统在日间手术中心的应用。方法回顾性分析2012年1月至2013年6月600例在日间手术中心用麦默通（Mammotome）微创活检乳腺病变组织,同时在超声引导下对一些良性肿瘤完整切除患者（研究组）的临床资料。选取同期500例常规住院患者作为对照组。结果研究组患者住院费用[（3204．5±215．6）元vs（7352．6±541．7）元]、在院时间【（13．7±3．4）hvs（86．7±12.3）h】明显优于对照组,差异有统计学意义（P〈O．05）。研究组并发症发生率与对照组比较差异无统计学意义（2％vs1．8％）。结论应用乳腺微创手术旋切系统可在日间手术中心完成乳腺病变组织快速活检及乳腺良性实性肿块切除术,具有损伤极小、疼痛轻、方便快捷等特点。     

Evaluation of inguinal hernia in ambulatory surgery: A prospective monocentric study on 1009 inguinal hernia

Ambulatory surgery for inguinal hernia has not been really developed in our country.

Aim

We evaluated the feasibility of inguinal hernia surgery on ambulatory.

Patients and methods

From January 1995 to June 2004, we performed 1009 inguinal hernia. There were 934 men (92.8%) and 75 women (7.2%). Middle age was 58.36 years (range: 7–95 years). All the patients were examined by their primary doctor on the first and the third day and by the surgeon on the tenth day after discharge. Telephone follow-up on the patient's condition was performed by a registered nurse on postoperative days 1 and 3.

Results

Eight hundred and thirty three patients were operated on by ambulatory surgery (82.5%). Overall morbidity was 8.5% (n = 86). Satisfaction index was excellent for 93.8% (n = 948). Locoregional anesthesia alone or associated with general anesthesia was used for 900 patients (98.1%). Only 466 patients (46.2%) were painful, 258 (25.55%) had a discomfort, and 285 (28.24%) had no symptomatology.

Conclusion

Tension-free technique under locoregional anesthesia for inguinal hernia allows ambulatory surgery with a low rate of morbidity and high satisfaction index.     

Laparoscopic versus open umbilical hernia repair.

BACKGROUND: The use of prosthetic material for open umbilical hernia repair has been reported to reduce recurrence rates. The aim of this study was to compare outcomes after laparoscopic versus open umbilical hernia repair. METHODS: We reviewed all umbilical hernia repairs performed from November 1995 to October 2000. Demographic data, hernia characteristics, and outcomes were compared. RESULTS: Of the 76 patients identified, 32 underwent laparoscopic repair (LR), 24 primary suture repairs (PSR), and 20 open repairs with mesh (ORWM). Preoperative characteristics were similar between groups. Hernia size was similar between LR and ORWM groups, and both were larger than that in the PSR group. ORWM compared with the other techniques resulted in longer operating time, more frequent use of drains, higher complication rates, and prolonged return to normal activities (RTNA). The length of stay (LOS) was longer in the ORWM than in the PSR group. When compared with ORWM, LR resulted in lower recurrence rates. LR resulted in fewer recurrences in patients with previous repairs and hernias larger than 3 cm than in both open techniques. CONCLUSIONS: LR results in faster RTNA, and lower complication and recurrence rates compared with those in ORWM. Patients with larger hernias and previous repairs benefit from LR.     

2018版腹股沟疝国际指南解读（日间手术部分）

全世界每年有超过2 000万台腹股沟疝手术。为了进一步标准化、减少并发症、改善手术结果,5个洲际疝协会（欧洲疝协会、美国疝协会、亚太疝协会、非洲中东疝协会、澳洲疝协会）、国际内镜疝协会以及欧洲内镜外科协会共同签署发布了腹股沟疝治疗国际指南（2018版）。笔者重点对其中有关日间手术的部分进行详细解读。     

Online patient resources for hernia repair: analysis of readability

Background

The limited functional health literacy of a significant portion of the adult US population negatively affects their access to appropriate online health information about hernia repair surgery. The National Institutes of Health and American Medical Association recommend that patient-directed content should be written at a sixth-grade reading level. This study aims to evaluate readability of the most frequently used Internet resources for patient information about hernia repair relative to average American literacy.

Methods

A web search for “hernia repair surgery” was performed, and the top 12 Web sites were identified. Relevant articles (n = 102) with patient-directed content immediately available from the main sites were downloaded. The 12 most popular consumer magazines in circulation were also identified, and using the same method, the first 10 articles were downloaded from each magazine's Web site for comparison. Readability was assessed using 10 established analyses. A t-test was used to compare the average grade level of hernia repair and magazine articles for each readability test.

Results

Web-based information about hernia repair had an overall average reading grade level of 13.6. All 102 articles were above the recommended sixth-grade reading level; these were significantly more difficult to read than the comparison group of articles from popular magazines.

Conclusions

Online patient-directed information about hernia repair uniformly exceeds the recommended reading level and may be too difficult to be understood by a large portion of the US population.     

Laparoscopic retroperitoneal repair of a right-sided Bochdalek hernia

Bochdalek hernias are rare congenital diaphragmatic defects. We report a case of a 50-year-old male with chronic shortness of breath who was diagnosed with a right-sided Bochdalek hernia. This hernia was repaired using a laparoscopic retroperitoneal approach.     

Criteria and benchmarks for laparoscopic cholecystectomy in a free-standing ambulatory center.

BACKGROUND AND OBJECTIVES: Keys to economic survival in an era of decreasing reimbursement include controlling costs and avoiding complications. In an effort to reduce costs, laparoscopic cholecystectomy has been performed with same-day discharge from a hospital setting. The free-standing ambulatory surgery center offers even greater cost savings if safety can be assured. Facility charges, surgical technique and instrument selection influence the costs of the procedure. METHODS: A database was accumulated prospectively on the first 100 laparoscopic cholecystectomies performed in a free-standing ambulatory surgery center to assess costs, logistical constraints, and safety. RESULTS: Laparoscopic cholecystectomies were accomplished in 99 of 100 patients. One patient was suspected of having cancer during laparoscopy and was transferred to a nearby hospital for open cholecystectomy. There were no other postoperative hospitalizations for complications. The fixed facility charge for the procedure was $2,990, and the total costs for all routinely disposable items (gowns, gloves, instruments, and adhesive bandages was $98. The mean OR time was 29 minutes (standard deviation 13.7). CONCLUSIONS: The free-standing ambulatory surgery center is an appropriate facility for an experienced operating team to perform laparoscopic cholecystectomy in selected patients. The surgeon's selection of appropriate energy sources and instruments is essential to complete the operation in a most cost-effective manner.     

Transmesenteric hernia after laparoscopic-assisted sigmoid colectomy.

BACKGROUND AND OBJECTIVES: Laparoscopic-assisted surgery has been applied for a variety of colonic surgery. The objective of this paper is to demonstrate a possible and avoidable complication of laparoscopic colonic surgery. CASE PRESENTATION: A 47-year-old woman underwent gasless laparoscopic-assisted sigmoid colectomy. On the 20th postoperative day, she developed bowel obstruction. Decompression with a long tube failed to resolve the bowel obstruction. Open laparotomy was performed. Abdominal exploration revealed a loop of the small bowel incarcerated in the mesenteric defect caused by the previous operation. Adhesiolysis was performed, and the postoperative course was uneventful. DISCUSSION: Despite technical difficulty, complete closure of the mesentery after bowel resection is strongly recommended for prevention of transmesenteric incarcerated hernia after laparoscopic surgery.     

日间手术中心复合局部麻醉下腰骶部筋膜脂肪疝的治疗

目的：探讨分析日间手术中心（ambulatory surgery center,ASC）复合局部麻醉下腰骶部筋膜脂肪疝的手术治疗体会。方法回顾性分析2012年10月至2013年7月,佛山市第一人民医院ASC接收手术治疗腰骶部筋膜脂肪疝患者33例的临床资料。手术方式：疝囊口扩大＋内容物切除术。麻醉方式：复方利多卡因乳膏表面麻醉＋哌卡因局部浸润麻醉。结果本组患者均在复合局部麻醉下顺利完成手术治疗,术中、术后无手术相关并发症发生。术后随访6个月,手术疗效价：优良率为93．94％。结论 ACS复合局部麻醉下手术治疗腰骶部筋膜脂肪疝疗效确切、安全可靠,减少了患者在院时间,节省了医疗成本。     

多媒体式术前访视在日间腹腔镜腹股沟疝手术患者的应用效果

目的研究多媒体式术前访视在日间腹腔镜腹股沟疝手术的效果。 方法选择2021年2-9月首都医科大学附属北京朝阳医院在日间手术模式下行腹腔镜腹股沟疝患者160例,采用抽签法平均分为对照组和研究组。对照组提供常规术前访视,研究组提供多媒体式术前访视,评估两种不同访视方式的效果,对比两组患者术前焦虑程度,入室后平均动脉压、心率值的变化程度,调查患者术后满意度。 结果焦虑程度研究组得分（34.35±1.40）分明显优于对照组（42.58±2.08）分,差异有统计学意义（P<0.05）。平均动脉压和心率升高值研究组（12.01±1.06）mmHg、（8.1±0.73）次/min优于对照组（17.95±1.26）mmHg、（13.7±1.21）次/min;手术满意度研究组（97.85±0.27）分优于对照组（95.11±0.45）分,差异均有统计学意义（P<0.001）。 结论在日间手术模式下应用多媒体进行术前访视能够减轻患者术前焦虑,降低因为不良心理状态引起的应激反应从而降低手术风险,提高患者手术满意度,加快日间手术周转。     

Laparoscopic ventral hernia repair: a single center experience

A retrospective chart review at the Carolinas Medical Center was performed on all patients who underwent laparoscopic ventral hernia repair (LVHR) from July 1998 through December 2003. LVHR was successfully completed in 270 of the 277 patients, or 98%, in whom it was attempted. Half of the patients (138/277) had at least one previous failed repair. The average defect measured 143.3 cm², and mesh was used in all repairs. The mean operating time was 168.3 min, mean blood loss was 50 cc, and average length of hospitalization was 3.0 days. Thirty-four complications occurred in 31 patients (11%). Only two mesh infections occurred (0.7%). At a mean follow-up period of 21 months, the rate of hernia recurrence was 4.7%. As experience grows and length of follow-up expands, LVHR may become the preferred approach for ventral hernia in difficult patients, especially obese patients and patients who have failed prior open repairs. Presented at the Annual Scientific Meeting of the American Hernia Society in Orlando, FL, February 26–28, 2004