One day surgery for hernia
XIII National Congress of Surgery with International Participation. BSS Sofia 2010, 641-643
Over 20,000 hernia operations of the anterior abdominal wall is performed annually Bulgaria1.
The risk of hernia is 27% in men and 3% of women2. This explains the great public importance of reducing hospital stay and reduces cost.
The definition of day surgery (one day surgery) is still not clear boundaries and includes the notion of stay from 23 to 47 hours. The trend of outpatient and day surgery units in specialized hernia develops upward for the past 30 years in the U.S. and Europe. In England, 75% of planned elective surgery to be this baza5. An increasing number of studies showing significantly fewer complications and recurrences shortened restoring normal rhythm learning3-4. Present the results of a series of personal hernioplastiki based day surgery.
Materials and methods
Treatment retrospectively studied 289 patients with 233 inguinal hernias and 56 ventral operated personally by the author Hospital "Vita" during the period from January 2006 to October 2009.
For the selection of patients for day surgery are complied factors in two ways:
1. Medical - lack of decompensated chronic pain. Research and consultation with an internist, anesthesiologist and specialists testimony and necessary preparations are done outpatient.
2. Social - the patient and his relatives should understand the nature of the operation and postoperative course and agree to its operation based day surgery to have a responsible adult to him for observation and assistance in the first three days, provide secure telephone, the ability to transport and adequate living conditions. For patients outside Sofia district provides accommodation for up to 48 hours near the hospital.
Patients hospitalized for about 1 hour before elective surgery, epilation operational flights are operated by private operators and immediately before surgery. Apply standard antibiotic prophylaxis with a second-generation cephalosporin - 2.0 g intravenously 30 minutes before surgery and intraoperative irrigation of the operative field with a solution of aminoglycoside.
In prosthesis (canvas) used Vypro II ® or Ultrapro ® of Ethicon ®.
In a Lichtenstein inguinal hernioplastiki Routine denervation in the area of the prosthesis.
Before dehospitalizatsiyata patients were personally supervised and instructed course postoperative period and possible complications. Provided was constant telephone communication with the operator.
Inspections are carried out at 2, 7, 30th day and every year. Distant results are reported for 234 (80.9%) patients. Analyzed operational methods, complications, recurrence, postoperative pain, duration of hospital stay, duration of absence from work.
The age of the patients was on average 51 (7-84) years. 251 were men and women 38. Increased body weight, BMI> 30 found in 34 (14.8%).
Ventral hernias 56 are distributed as follows: 26 postoperative, 23 umbilical, epigastric 6, 1 Shpigelova hernia. In all ventral hernias we applied preperitonealno available on canvas Stoppa-Rives under general anesthesia.
We did not use drains.
So are 199 primary and 31 recurrent (13.5%). Sliding were 21 (9.1%) hernia and giant ingvinoskrotalni were 15 (6.5%).
Attached are 156 (67%) prosthetic plastic - 148 Lichtenstein and our modification of a preperitoneal Moran-Maden in 8 cases.
In young patients with hernias have used T2 plastikapo Marcy 19 cremasteric and further strengthening in our methodology in 14 cases.
For the remaining 58 patients are applied plastics own tissues: the Shouldice at 3, Mc Vay in femoral by Andrews in 12 so-called physiological sculpture of the author Desarda in 19 patients.
Anesthesia in 155 (67%) cases had spinal and 67 (28%) local and general za11 (5%).
Drainage we have used in 6 (2.6%) patients with large recurrent hernias.
Average hospital stay was 18 hours, with 23 (10%) of patients dehospitalizirani the same day. Stays longer than 24 hours were in the 5 th (1.73%). Rehospitalisation need in 2 (0.69%) patients. When a man with hypertensive crisis and one with a swollen scrotum.
Early postoperative complications were treated in 4 (1.38%) - hematoma in the wound for three. Revision of skin and hemostasis Court need for one. Swelling of the scrotum in a patient operated on for giant ingvinoskrotalna hernia. There was no infection in the surgical wound. In inguinal hernioplastiki until relapse was observed. Relapse was reported in two (3.57%) patients with abdominal hernias. Period to restore normal rhythm of life (driving a car, and office work) is the average of 9 days.
Advanced age and chronic diseases are often a pretext for advice from GPs and relatives to refrain from abdominal hernia surgery. They readily accepted by patients and led to an increase in hernia to gigantic proportions, deteriorating quality of life and surgical treatment coercion in more advanced age. Our experience supports podhoda5 that is important, not age, and physiological status of the patient and sustainable compensation of chronic diseases.
In ventral hernia preperitonealnoto prosthesis allows for minimal dissection under the skin without the use of drain allows for day surgery.
In inguinal hernia share a prosthetic plastic is lower than current standards EHS6. This policy is determined by the NHIF and economic crisis and an examination and introduction of a plastic Desarda7, 8
Most patients discharged after an overnight stay, mainly due to strict requirement of the NHIF. Wound infection, especially plastic prosthesis is a disaster for both patient and surgeon. In our series no wound complications in the surgical wound indulge in compliance with the protocol proposed by M. Deysine9.
The surgical treatment of abdominal hernia in a day surgery an adequate selection of patients with excellent results in significant patient satisfaction and significantly reduced costs.
1. Damyanov D. Stages in the surgical treatment of inguinal hernia. Highlights choice of operating equipment. "Hernia" Edited by Prof. Damyan Damyanov Medar 1997
2. Primatesta P, Goldacre MJ. (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemio125 :835-839
3. Deysine M, Grimson RC, Soroff HS. (1991) Inguinal herniorrhaphy: reduced morbidity by service standardisation. Arch Surg 126: 628-63o 4.Millikan KW, Deziel DJ. (1996) The management of hernia: considerations in cost-effectiveness. Surg Clin NAmer 76: lo5-116
5. Day surgery 2005 British Association of Day Surgery and The assosietion of anesthetists of Great Britan and Ireland. 21 Portland Place, London
6. Treatment of Inguinal Hernia in Adult Patients. European Hernia Society Guidelines
7. Desarda M. P. Surgical physiology of inguinal hernia repair - a study of 200 cases: BMC Surgery 2003 3:2
8. Desarda M. P. Physiological repair of inguinal hernia-A new technique (Study of 860 patients) Hernia. (2006) 10:143-146
9. Deysine M. Hernia clinic in a teaching institution: creation and development
2001, Volume 5, Number 2, Pages 65-69