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Matovu A, Nordin P, Wladis A, Ajiko MM, Löfgren J. Groin Hernia Surgery in Uganda: Caseloads and Practices at Hospitals Operating Within the Publicly Funded Healthcare Sector. World J Surg 2020; 44:3277-3283. [PMID: 32542447 PMCID: PMC7458893 DOI: 10.1007/s00268-020-05633-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Groin hernia is a major public health problem with over 200 million people affected. The unmet need for surgery is greatest in Sub-Saharan Africa where specialist surgeons are few. This study was carried out in Uganda to investigate caseloads and practices of groin hernia surgery at publicly funded hospitals. Methods The study employed mixed methods covering 29 hospitals: the National Referral Hospital (NRH), 14 Regional Referral Hospitals (RRH) and 14 General Hospitals (GH). In part one of the study, surgeons and medical doctors performing hernia repair were interviewed about their practices and experiences of groin hernia surgery. In part two, operating theater records from 2013 to 2014 from the participating hospitals were reviewed and information about groin hernia operations collected. Results All respondents reported that sutured repair was the first-choice method. A total of 5518 groin hernia repairs were performed at the participating hospitals, i.e., an annual hernia repair rate of 7/100 000 population. Of the patients operated, almost 16% were women and 24% were children. Local anesthesia (LA) was used in 40% of the cases, and non-surgeon physicians performed 70.3% of the groin hernia repairs. Conclusion Groin hernia repair outputs need to increase along with the training of surgical providers in modern hernia repair methods. Methods and outcomes for hernia repair in women and children should be investigated to improve the quality of care.
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Affiliation(s)
- Alphonsus Matovu
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176, Stockholm, Sweden. .,Department of Surgery, Mubende Regional Referral Hospital, Plot M.4 Kakumiro Road, P.O Box 4, Mubende, Uganda.
| | - Pär Nordin
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Andreas Wladis
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Mary Margaret Ajiko
- Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden
| | - Jenny Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden
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Rajapaksha K, Silva LJCM, Herath A, D Anandappa MJ, Bandara TMIG. Impact of institutional hernia programme on guideline conformity of surgical approach and mode of anesthesia for inguinal hernia repair and analysis of the outcomes. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2019. [DOI: 10.4103/ijawhs.ijawhs_14_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Romano G, Calò PG, Erdas E, Medas F, Gordini L, Podda F, Amato G. Fixation-free incisional hernia repair in the elderly: our experience with a tentacle-shaped implant. Aging Clin Exp Res 2017; 29:173-177. [PMID: 27837460 DOI: 10.1007/s40520-016-0651-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/12/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Incisional hernia in aged patients represents a challenge even for experienced surgeons. Besides increased risk of complications due to comorbidities, mesh fixation and assuring a sufficient mesh overlap of the defect are the main issues in carrying out the repair. AIMS In order to assure broader coverage of the abdominal wall and a tension- and fixation-free repair, a specifically designed prosthesis was developed for the surgical treatment of incisional hernias. The results of a fixation-free incisional hernia repair carried out in elderly patients using a tentacle-shaped implant are reported herewith. METHODS A tentacle-shaped flat mesh with a large central body and integrated arms was used to repair incisional hernia in 23 elderly patients. The mesh was placed fixation-free and secured in place through the friction exerted by the tentacles. All tentacle straps were positioned with a special passer needle. Implant placement was preperitoneal in 18 patients and retromuscular sublay in five. RESULTS In a follow-up of 18 to 59 months (mean 36 months), four seromas occurred. Postoperative fast track helped avoid the typical complications affecting this patient subset. No infection, hematoma, chronic pain, mesh dislocation or recurrence have been reported to date. DISCUSSION The tentacle strap system allowed for reduced skin incision thus minimizing surgical trauma and ensuring easier and faster implant placement. CONCLUSION The tentacle arms of the implant ensured mesh stability and broad defect overlap. Besides a very low complication rate, none of the typical postoperative complications of aged patients occurred.
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Affiliation(s)
- Giorgio Romano
- Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Pier Giorgio Calò
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - Enrico Erdas
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - Fabio Medas
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - Luca Gordini
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - Francesco Podda
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - Giuseppe Amato
- Postgraduate School of General Surgery, University of Cagliari, Cagliari, Italy.
- , via M. Rapisardi 66, 90144, Palermo, Italy.
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Combined inguinal hernia in the elderly. Portraying the progression of hernia disease. Int J Surg 2016; 33 Suppl 1:S20-9. [DOI: 10.1016/j.ijsu.2016.05.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ferrarese A, Enrico S, Solej M, Surace A, Nardi MJ, Millo P, Allieta R, Feleppa C, D'Ambra L, Berti S, Gelarda E, Borghi F, Pozzo G, Marino B, Marchigiano E, Cumbo P, Bellomo MP, Filippa C, Depaolis P, Nano M, Martino V. Laparoscopic management of non-midline incisional hernia: A multicentric study. Int J Surg 2016; 33 Suppl 1:S108-13. [PMID: 27353846 DOI: 10.1016/j.ijsu.2016.06.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The laparoscopic repair of non-midline ventral hernia (LNM) has been debated. The aim of this study is to analyze our experience performing the laparoscopic approach to non-midline ventral hernias (NMVHs) in Northwest Italy for 6 years. METHODS A total of 78 patients who underwent LNM between March 2008 and March 2014 in the selected institutions were analyzed. We retrospectively analyzed the peri- and postoperative data and the recurrence rate of four subgroups of NMVHs: subcostal, suprapubic, lumbar, and epigastric. We also conducted a literature review. RESULTS No difference was found between the four subgroups in terms of demographic data, defect characteristics, admission data, and complications. Subcostal defects required a shorter operating time. Obesity was found to be a risk factor for recurrence. CONCLUSIONS In our experience, subcostal defects were easier to perform, with a lower recurrence rate, lesser chronic pain, and faster surgical performance. A more specific prospective randomized trial with a larger sample is awaited. Based on our experience, however, the laparoscopic approach is a safe treatment for NMVHs in specialized centers.
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Affiliation(s)
- Alessia Ferrarese
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Alessandra Surace
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | | | - Paolo Millo
- Hospital "Umberto Parini", Section of General Surgery, Aosta, Italy.
| | - Rosaldo Allieta
- Hospital "Umberto Parini", Section of General Surgery, Aosta, Italy.
| | - Cosimo Feleppa
- Hospital "Sant'Andrea", Section of General Surgery, La Spezia, Italy.
| | - Luigi D'Ambra
- Hospital "Sant'Andrea", Section of General Surgery, La Spezia, Italy.
| | - Stefano Berti
- Hospital "Sant'Andrea", Section of General Surgery, La Spezia, Italy.
| | - Enrico Gelarda
- Hospital "Santa Croce e Carle", Section of General Surgery, Cuneo, Italy.
| | - Felice Borghi
- Hospital "Santa Croce e Carle", Section of General Surgery, Cuneo, Italy.
| | - Gabriele Pozzo
- Hospital "Civile", Section of General Surgery, Asti, Italy.
| | | | - Emma Marchigiano
- Hospital "Santa Croce", Section of General Surgery, Moncalieri, Italy.
| | - Pietro Cumbo
- Hospital "Santa Croce", Section of General Surgery, Moncalieri, Italy.
| | | | - Claudio Filippa
- Hospital "Gradenigo", Section of General Surgery, Torino, Italy.
| | - Paolo Depaolis
- Hospital "Gradenigo", Section of General Surgery, Torino, Italy.
| | - Mario Nano
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
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Mason SE, Scott AJ, Mayer E, Purkayastha S. Patient-related risk factors for urinary retention following ambulatory general surgery: a systematic review and meta-analysis. Am J Surg 2016; 211:1126-34. [DOI: 10.1016/j.amjsurg.2015.04.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/22/2015] [Accepted: 04/25/2015] [Indexed: 11/26/2022]
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Chen T, Zhang Y, Wang H, Ni Q, Yang L, Li Q, Wang J. Emergency inguinal hernia repair under local anesthesia: a 5-year experience in a teaching hospital. BMC Anesthesiol 2016; 16:17. [PMID: 26994892 PMCID: PMC4799842 DOI: 10.1186/s12871-016-0185-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 03/17/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Local anesthesia (LA) has been reported to be the best choice for elective open inguinal hernia repair because it is cost efficient, with less post-operative pain and enables more rapid recovery. However, the role of LA in emergency inguinal hernia repair is still controversial. The aim of this study is to investigate the safety and effectiveness of LA in emergency inguinal hernia repair. METHODS All patients underwent emergency inguinal hernia repair in our hospital between January 2010 and April 2014 were analyzed retrospectively in this study. Patients were divided into LA and general anesthesia (GA) group according to the general conditions of the patients decided by anesthetists and surgeons. The outcome parameters measured included time to recovery, early and late postoperative complications, total expense and recurrence. RESULTS This study included a total of 90 patients from 2010 to 2015. 32 patients (35.6%) were performed under LA, and 58 (64.4%) were performed under GA. LA group has less cardiac complications (P = 0.044) and respiratory complications (P = 0.027), shorter ICU stay (P = 0.035) and hospital stay (P = 0.001), lower cost (P = 0.000) and faster recovery time (P = 0.000) than GA group. CONCLUSION LA could provide effective anesthesia and patient safety in emergency inguinal hernia repair.
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Affiliation(s)
- Tao Chen
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 S. Dongfang Road, Shanghai, 200127, China
| | - Yunhe Zhang
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 S. Dongfang Road, Shanghai, 200127, China
| | - Haolu Wang
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 S. Dongfang Road, Shanghai, 200127, China.,Therapeutics Research Centre, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Qihong Ni
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 S. Dongfang Road, Shanghai, 200127, China
| | - Linhua Yang
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 S. Dongfang Road, Shanghai, 200127, China
| | - Qiwei Li
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 S. Dongfang Road, Shanghai, 200127, China
| | - Jian Wang
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 S. Dongfang Road, Shanghai, 200127, China.
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Voorbrood CEH, Burgmans JPJ, Clevers GJ, Davids PHP, Verleisdonk EJMM, van Dalen T. Totally extraperitoneal (TEP) endoscopic hernia repair in elderly patients. Hernia 2015; 19:887-91. [PMID: 26395580 DOI: 10.1007/s10029-015-1422-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 08/18/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inguinal hernias are common in elderly males. We addressed outcome following totally extraperitoneal (TEP) hernia repair in patients older than 70 years. METHODS We prospectively collected data of patients >70 years with a unilateral or bilateral inguinal hernia operated in our hospital between January 2005 and January 2010 using the TEP technique. RESULTS A total of 429 patients underwent TEP hernia repair under general anaesthesia, mostly men (n = 405; 94.4%). Median age was 74 years (range 70-89). The mean pre-operative pain score was 3.7 (SD ± 2.5). Ninety-four percent of patients had an ASA score of 1 or 2. Three hundred thirty-six patients underwent a unilateral repair (78%). The conversion rate to an anterior procedure was 0.7 % (n = 3). In 8 patients (1.9%), intra-operative complications occurred, and the postoperative course was complicated in 3 patients (0.7 %). Severe complications attributable to the endoscopic approach occurred in 6 patients (1.4%): a bladder injury (n = 5) and a trocar-induced bowel perforation (n = 1). The mean postoperative pain score after 6 weeks was 1.6 (SD ± 1.2). Patients were able to resume their daily activities after a median of 7 days (range 1-42). CONCLUSION Totally, extraperitoneal endoscopic inguinal hernia repair in elderly patients is associated with low overall complication rates and a fast recovery. In a small proportion of patients, severe complications occur attributable to the endoscopic approach.
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Affiliation(s)
- C E H Voorbrood
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
| | - J P J Burgmans
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
| | - G J Clevers
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
| | - P H P Davids
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
| | - E J M M Verleisdonk
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
| | - T van Dalen
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
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Caglià P, Tracia A, Borzì L, Amodeo L, Tracia L, Veroux M, Amodeo C. Incisional hernia in the elderly: Risk factors and clinical considerations. Int J Surg 2014; 12 Suppl 2:S164-S169. [DOI: 10.1016/j.ijsu.2014.08.357] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 01/03/2023]
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Ferrarese A, Marola S, Surace A, Borello A, Bindi M, Cumbo J, Solej M, Enrico S, Nano M, Martino V. Fibrin glue versus stapler fixation in laparoscopic transabdominal inguinal hernia repair: a single center 5-year experience and analysis of the results in the elderly. Int J Surg 2014; 12 Suppl 2:S94-S98. [PMID: 25183643 DOI: 10.1016/j.ijsu.2014.08.371] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Inguinal hernia surgery is one of the most common surgical procedures performed worldwide. Some studies demonstrated clear advantages of laparoscopic approach in terms of chronic pain, recurrence rate and daily life activities Aim of this study was to compare short and long-terms outcome of tacks and fibrin glue used during laparoscopic transabdominal hernioplasty (TAPP). METHODS This is a retrospective study conducted by our division of General Surgery. From May 2008 to May 2013 we performed 116 hernioplasty with TAPP technique. We compared two groups of patients: a group of 59 patients treated with fibrin glue and a group of 57 patients treated with conventional tacks and the two subgroups of patients over 65 years old. We evaluated: perioperative outcomes, early and late complications. RESULTS There were no significative difference about length of postoperative stay, time to return to work, recurrence rate and complications. DISCUSSION This study demonstrates that fibrin glue are same tolerated than tacks by patients and that the glues lead to the same good results during initial follow-up and in long term data also in the elderly. Meticulous preparation of the groin with preservation of spermatic sheet is in our opinion necessary to provide effective pain reduction and a good result in every TAPP procedure.
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Affiliation(s)
- Alessia Ferrarese
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Silvia Marola
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Alessandra Surace
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Alessandro Borello
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Marco Bindi
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Jacopo Cumbo
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Mario Nano
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
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Compagna R, Vigliotti G, Bianco T, Amato M, Rossi R, Fappiano F, Accurso A, Danzi M, Aprea G, Amato B. Local anesthesia for treatment of hernia in elder patients: Levobupicavaine or Bupivacaine? BMC Surg 2013; 13 Suppl 2:S30. [PMID: 24267484 PMCID: PMC3851157 DOI: 10.1186/1471-2482-13-s2-s30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Inguinal hernia is one of the most common diseases in the elderly. Treatment of this pathology is exclusively surgical and relies almost always on the use of local anesthesia. While in the past hernia surgery was carried out mainly by general anesthesia, in recent years there has been growing emphasis on the role of local anesthesia. Methods The aim of our study was to compare intra-and postoperative analgesia obtained by the use of levobupivacaine to the same obtained by bupivacaine. Bupivacaine is one of the main local anesthetics used in the intervention of inguinal hernioplasty. Levobupivacaine is an enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity. The study was conducted from March 2011 to March 2013. We collected data of eighty patients, male and female, aged between 65 and 86 years, who underwent inguinal hernioplasty with local anesthesia. Results Evaluation of intra-operatively pain shows that minimal pain is the same in both groups. Mild pain was more frequent in the group who used levobupivacaine. Moderate pain was slightly more frequent in the group who used bupivacaine. Only one reported intense pain. Two drugs seem to have the same effect at a distance of six, twelve, eighteen and twentyfour hours. Bupivacaine shows a significantly higher number of complications, as already demonstrated by previous studies. Degree of satisfaction expressed by patients has been the same in the two groups. Levobupivacaine group has shown a greater request for paracetamol while patients who experienced bupivacaine have showed a higher request of other analgesics. Conclusions Clinical efficacy of levobupivacaine and racemic bupivacaine are actually similar, when used under local intervention of inguinal hernioplasty. In the field of ambulatorial surgery our working group prefers levobupivacaine for its fewer side effects and for its easy handling.
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Amato B, Compagna R, Fappiano F, Rossi R, Bianco T, Danzi M, Accurso A, Serra R, Aprea G, Massa S. Day-surgery inguinal hernia repair in the elderly: single centre experience. BMC Surg 2013; 13 Suppl 2:S28. [PMID: 24267293 PMCID: PMC3851140 DOI: 10.1186/1471-2482-13-s2-s28] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inguinal hernioplasty is well established as a day-surgery procedure, our purpose is to assess the safeness of this approach in elderly patients. METHODS A total of 292 inguinal hernioplasty were performed between June 2009 and February 2013. Patients were divided into 3 groups depending on the age and postoperative complications were compared in these groups. RESULTS Despite of a large number of higher risk (ASA 3-4) patients and a higher rate of comorbidity in older patients, unplanned admission postoperative, symptoms and complications were comparable with those for the younger patients. CONCLUSIONS Ambulatory surgery is feasible also in older patients. Age, comorbidity and higher ASA risk should not be a barrier to elective day surgery.
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Affiliation(s)
- Bruno Amato
- Department of Clinical Medecine and Surgery University of Naples Federico II Via S. Pansini, 5 - 801311 Napoli, Italy
| | - Rita Compagna
- Department of Clinical Medecine and Surgery University of Naples Federico II Via S. Pansini, 5 - 801311 Napoli, Italy
| | - Francesca Fappiano
- Department of Clinical Medecine and Surgery University of Naples Federico II Via S. Pansini, 5 - 801311 Napoli, Italy
| | - Roberto Rossi
- Department of Clinical Medecine and Surgery University of Naples Federico II Via S. Pansini, 5 - 801311 Napoli, Italy
| | - Tommaso Bianco
- Department of Clinical Medecine and Surgery University of Naples Federico II Via S. Pansini, 5 - 801311 Napoli, Italy
| | - Michele Danzi
- Department of Clinical Medecine and Surgery University of Naples Federico II Via S. Pansini, 5 - 801311 Napoli, Italy
| | - Antonello Accurso
- Department of Clinical Medecine and Surgery University of Naples Federico II Via S. Pansini, 5 - 801311 Napoli, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Science -University Magna Gracia of Catanzaro - Viale Europa, Località Germaneto - 88100 Catanzaro, Italy
| | - Giovanni Aprea
- Department of Clinical Medecine and Surgery University of Naples Federico II Via S. Pansini, 5 - 801311 Napoli, Italy
| | - Salvatore Massa
- Department of Clinical Medecine and Surgery University of Naples Federico II Via S. Pansini, 5 - 801311 Napoli, Italy
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Ferrarese AMDG, Enrico S, Solej M, Falcone A, Catalano S, Gibin E, Marola S, Surace A, Martino V. Transabdominal pre-peritoneal mesh in inguinal hernia repair in elderly: end point of our experience. BMC Surg 2013; 13 Suppl 2:S24. [PMID: 24266979 PMCID: PMC3851048 DOI: 10.1186/1471-2482-13-s2-s24] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Aim of this study is to present our standardized laparoscopic transabdominal preperitoneal hernia repair (TAPP) technique, and to study our experience in the elderly as far as concerns preoperative and postoperative variables. METHODS We described our standardized TAPP technique according with Stuttgart technique 1, and we evalutated our team's experience in TAPP inguinal hernia repair in elderly (> 65 yrs) and in young patients (< 65 yrs). RESULTS We retrospectively reviewed our Surgery Division's experience about TAPP; we included in our study 185 patients. The sample was subdivided in two groups: TAPP Group (< 65 years patients) and TAPPe Group (> 65 years patients). TAPP Group was composed by 154 patients and TAPPe Group of 31 patients. According with literature, in this subgroup recurrence rate (3,2%), early and delayed complications and mean operative time (86 min). There were no major vascular or intestinal complications. At the moment follow-up is 31 months. There were no incisional hernias on umbilical trocar. Mean satisfaction rate was excellent also in elderly patients. CONCLUSIONS According with literature, in our experience TAPP technique is a safe and feasible procedure, even in elderly patients.
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Affiliation(s)
- Alessia MDG Ferrarese
- University of Turin - Department of Oncology - School of Medicine - Teaching Hospital "San Luigi Gonzaga" - Section of General Surgery - Orbassano - Turin, Italy
| | - Stefano Enrico
- University of Turin - Department of Oncology - School of Medicine - Teaching Hospital "San Luigi Gonzaga" - Section of General Surgery - Orbassano - Turin, Italy
| | - Mario Solej
- University of Turin - Department of Oncology - School of Medicine - Teaching Hospital "San Luigi Gonzaga" - Section of General Surgery - Orbassano - Turin, Italy
| | - Alessandro Falcone
- University of Turin - Department of Oncology - School of Medicine - Teaching Hospital "San Luigi Gonzaga" - Section of General Surgery - Orbassano - Turin, Italy
| | - Silvia Catalano
- University of Turin - Department of Oncology - School of Medicine - Teaching Hospital "San Luigi Gonzaga" - Section of General Surgery - Orbassano - Turin, Italy
| | - Enrico Gibin
- University of Turin - Department of Oncology - School of Medicine - Teaching Hospital "San Luigi Gonzaga" - Section of General Surgery - Orbassano - Turin, Italy
| | - Silvia Marola
- University of Turin - Department of Oncology - School of Medicine - Teaching Hospital "San Luigi Gonzaga" - Section of General Surgery - Orbassano - Turin, Italy
| | - Alessandra Surace
- University of Turin - Department of Oncology - School of Medicine - Teaching Hospital "San Luigi Gonzaga" - Section of General Surgery - Orbassano - Turin, Italy
| | - Valter Martino
- University of Turin - Department of Oncology - School of Medicine - Teaching Hospital "San Luigi Gonzaga" - Section of General Surgery - Orbassano - Turin, Italy
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15
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Donati M, Brancato G, Giglio A, Biondi A, Basile F, Donati A. Incidence of pain after inguinal hernia repair in the elderly. A retrospective historical cohort evaluation of 18-years' experience with a mesh & plug inguinal hernia repair method on about 3000 patients. BMC Surg 2013; 13 Suppl 2:S19. [PMID: 24268023 PMCID: PMC3850950 DOI: 10.1186/1471-2482-13-s2-s19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Chronic pain after prosthetic inguinal hernioplasty is one of the most important current issues in the current literature debate. Mechanisms related to pain development are only partially known. Influence of age as well as other factors is still unclear. The aim of this work was to evaluate whether development of chronic pain after open prosthetic plug and mesh inguinal hernioplasty is influenced by age. Methods Analysis was retrospectively conducted, dividing our cohort of patients (2,902) who had undergone prosthetic open plug&mesh inguinal hernioplasty from Jannuary 1994 to May 2012, following only the age criterion (cut-off 65 yrs.), into two groups (Gr.A<65 yrs, Gr.B>65 yrs.). All patients were routinely submitted to a postoperative questionnaire. Complications such as analgesic assumption were registered in both groups. Pain intensity was classified following the Visual Analogic Scale (VAS). Incidence of chronic pain, discomfort, and numbness, was assessed in both groups. Statistical significance was assessed by X2-test. Results Only 0.2% of patients suffered from a recurrence in our cohort. Postoperative chronic pain was observed in Gr. A in 0.12% of patients vs Gr.B 0.09% (p>0.05). Incidence of other postoperative symptoms such as discomfort or numbness were slightly prevalent on young patients (respectively p = 0.0286 and p = 0.01), while for hyperesthesia and sensation of foreign body no statistically significant difference of incidence between groups was observed. Conclusions Real chronic pain after inguinal hernioplasty is a rare clinical entity. Other causes of chronic pain should be accurately researched and excluded. In young patients psychological factors seem to show a slight influence. There was no influence of age on chronic postoperative pain incidence after inguinal hernioplasty.
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16
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Compagna R, Rossi R, Fappiano F, Bianco T, Accurso A, Danzi M, Massa S, Aprea G, Amato B. Emergency groin hernia repair: implications in elderly. BMC Surg 2013; 13 Suppl 2:S29. [PMID: 24267391 PMCID: PMC3851200 DOI: 10.1186/1471-2482-13-s2-s29] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Groin hernia is one of the most frequently encountered pathologies occurring in old age and it is often the cause of emergency procedures. In our study we evaluate the impact of emergency procedures in over 75 patients compared to younger patients. METHODS We conducted a retrospective study about patients who underwent emergency hernioplasty between September 2007 and January 2013. Bilateral hernias and recurrences were excluded. We divided patients into two groups by age (under and over 75 years old) and then analyzed the early postoperative surgical complications. RESULTS A total of 48 patients were enrolled, 18 were included in under 75 group and 30 in over 75. In the older group we found a higher rate of comorbidity and also a significant higher rate of postoperative complications. Two patients of over 75 group died. CONCLUSIONS Our data suggests that a quick diagnosis and elective surgical procedures are desirable in order to avoid the complications that occur in emergency operations.
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Affiliation(s)
- Rita Compagna
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5 - 80131 Napoli, Italy
| | - Roberto Rossi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5 - 80131 Napoli, Italy
| | - Francesca Fappiano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5 - 80131 Napoli, Italy
| | - Tommaso Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5 - 80131 Napoli, Italy
| | - Antonello Accurso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5 - 80131 Napoli, Italy
| | - Michele Danzi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5 - 80131 Napoli, Italy
| | - Salvatore Massa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5 - 80131 Napoli, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5 - 80131 Napoli, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5 - 80131 Napoli, Italy
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Griebling TL. Detrusor Underactivity and Urinary Retention in Geriatric Patients: Evaluation, Management and Recent Research. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0183-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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