Day case hernia repair: weak evidence or practice gap?

Scarfe, Anje; Duncan, Joanna; Ma, Ning; Cameron, A Scott; Rankin, David; Karatassas, Alex; Fletcher, David; Watters, David; Maddern, Guy J.

doi:10.1111/ans.14302

Cited by 16 publications

(21 citation statements)

References 30 publications

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“…En el 2004 la Agencia Nacional de Salud (NHS) de Inglaterra publicó una guía explicando los 10 cambios de alto impacto con el fin de mejorar los servicios de salud y disminuir la lista de espera para cirugías electivas, con fuerte recomendación de cirugía ambulatoria para la hernia inguinal (8) . En el 2013 se aprobó la directiva que permite el funcionamiento de la Unidad de Cirugía Mayor Ambulatoria (UCMA) en el Hospital Cayetano Heredia (HCH) en donde la cirugía de hernia inguinal está entre los procedimientos seleccionados (3) .…”

Section: Discussionunclassified

“…En este escenario, en el 2013, se aprobó la directiva que permitió el funcionamiento de la Unidad de Cirugía Mayor Ambulatoria (UCMA) en nuestro hospital, con la finalidad que pacientes quirúrgicos, entre los que se encontraban aquellos con diagnóstico de hernia inguinal y que cumplían con los requisitos de esta directiva, podrían operarse en forma ambulatoria (2) . La cirugía de la hernia en programas de cirugía ambulatoria, comparados con los sistemas de hospitalización, demostraron la misma seguridad y efectividad, alta aceptación por los pacientes y menores costos (3) . La técnica operatoria considerada como referencia de la reparación de hernia inguinal es la hernioplastía de Lichtenstein (cirugía sin tensión con el uso de malla).…”

Section: Introductionunclassified

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Clinical outcomes of ambulatory surgical treatment of unilateral inguinal hernia

Vigil-Guerrero¹,

Yrigoyen

2022

Rev Med Hered

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Objetivo: Describir los resultados clínicos del tratamiento de pacientes con hernia inguinal unilateral (HIU) realizados en una unidad de cirugía mayor ambulatoria de un hospital de nivel III. Material y métodos: Se revisaron las historias clínicas de los pacientes operados de HIU en la Unidad de Cirugía Mayor ambulatoria (UCMA) del Hospital Cayetano Heredia (HCH) entre julio del 2013 y junio del 2016. Resultados: El número final de pacientes incluidos fue 154. La edad promedio fue 43 años; 101 (65,6%) fueron varones; 104 (67,5%) tenían riesgo quirúrgico ASA I; 12 (7,8%) tenían enfermedades asociadas; 94 (61,0%) se operaron con la técnica abierta, y 60 (39,0%) por la vía laparoscópica. La cirugía laparoscópica fue usada con más frecuencia en las mujeres (p=0.037). El tiempo operatorio fue mayor en la cirugía laparoscópica (p=0.033). No hubo diferencia significativa con respecto a la edad, riesgo quirúrgico, complicaciones anestésicas y complicaciones quirúrgicas entre pacientes operados con cirugía abierta y con cirugía laparoscópica. En total 34 (22%) pacientes no salieron de alta el mismo día de la cirugía: Ocho (5,2%) pacientes por presentar complicaciones y 26 (16,8%) pacientes por razones administrativas/ sociales. Conclusión: La cirugía ambulatoria de HIU en adultos realizada por la técnica abierta o laparoscópica, es un procedimiento seguro que permite el alta del paciente el mismo día de la cirugía.

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Section: Discussionunclassified

Section: Introductionunclassified

Clinical outcomes of ambulatory surgical treatment of unilateral inguinal hernia

Vigil-Guerrero¹,

Yrigoyen

2022

Rev Med Hered

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“…However, there are only a few studies that focus on umbilical hernia repair and less on trocar hernia repair. Especially in the ambulatory setting, reports are missing [ 3 ]. Open mesh repair (OMR) may be associated with a lower risk of recurrence, but a higher risk of seroma formation when compared with suture repair.…”

Section: Introductionmentioning

confidence: 99%

Trocar umbilical hernia repair by open suture repair and open suture–mesh repair in an ambulatory setting in comparison to recurrent and primary umbilical hernia repair

Holzheimer¹,

Gaschütz

2020

Journal of Surgical Case Reports

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Reports on the ambulatory open repair of umbilical trocal hernias are missing. Patients with trocar, primary and recurrent umbilical hernia open suture and open suture–mesh repair with prospective follow-up were retrospectively evaluated. Patients received perioperative antibiotic prophylaxis, preemptive analgesia and modified anesthesia. In total, 171 patients with umbilical hernia (51 years, female 14%; male 86%) were treated with open suture (n = 29; 17%) and suture–mesh (n = 142; 83%) repair. In total, 10% of patients were treated for trocar hernia (late onset), 5% for recurrent hernia and 85% for a primary umbilical hernia. In total, 29% of trocar hernia repairs had minor complications associated with obesity (40%) and comorbidity (80%). Age, suture and suture–mesh repair were not associated with complications. According to guidelines for umbilical hernia repair open flat mesh may be useful in the treatment of trocar hernia.

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“…Although outpatient surgery is considered safe, we question whether surgeons might be losing personal contact with their patients too early [11]. Traditionally, nurses and surgeons have been monitoring complications and encouraging early mobilization in the ward.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Tablet-Based Telemonitoring After Abdominal Wall Hernia Surgery: Pilot Prospective Observational Cohort Study (Preprint)

Gräfitsch¹,

Kirchhoff²,

Hoffmann³

et al. 2019

Preprint

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BACKGROUND The economic burden of general surgical procedures is a major contributor to health costs all over the world. To reduce these costs and to enhance patient comfort, more and more procedures are transferred to a daycase setting, already e.g. hernias of the abdominal wall are repaired without keeping the patient overnight in a lot of countries. In the future, it is very likely that more complex procedures are considered to be safe to be carried out this way too. Up to now, we cannot offer our patients any intensified monitoring, once they have left the hospital. Tablet-based telemonitoring seems to be a promising way to change this situation. OBJECTIVE The rationale for this study was to evaluate the feasibility of monitoring postoperative activity with a telemonitoring device after minor surgery of the abdominal wall. METHODS Patients aged 18 and older, scheduled for elective surgical repair of abdominal wall hernias were equipped with a telemonitoring system including a tablet, a pulse-oximeter and an actimeter for a monitoring phase of one week before and five weeks after surgery. The primary objective was the feasibility of monitoring postoperative activity, secondary objectives were monitoring of pain and the impact of wound photographs for surveillance and early detection of surgical site infections (SSI). RESULTS We enrolled 16 patients (5 (31.3%) female, 11 (68.8%) male) with an age of mean±SD (Standard Deviation) 48.75 ± 16.28 between October 2017 and September 2018 in our center. Regarding our primary objective, we were able to gather information relating to the patient activity levels in all patients, except one. This resulted in a response rate of 75 percent in the preoperative week, with declining rates over the follow-up period. The gathered steps per week showed broad variations over the study period with e.g. in the preoperative week mean±SD 27951.00 ± 21036.56 steps, mean±SD 1523.17 ± 9345.58 in the 1st postoperative week and mean±SD 21019 ± 15865.21 steps in the 5th postoperative week. Regarding the secondary objectives, the maximum VAS was mean±SD 4,24 ± 1,81 with a duration of transferred VAS-data of mean±SD 14,19 ± 8,67 days postoperatively. In the first week after the operation, VAS-data was transferred completely on 1 to 6 days, but the rate continuously decreased over the following four weeks, resulting in no data transmission at all in 62,5 percent of the cases in the 5th week. There occurred no SSI during the follow-up period. CONCLUSIONS Our study showed, in principle, the feasibility of a tablet-based follow-up after repair of small hernias of the abdominal wall. Further studies should target to optimize technical issues and focus on general surgical procedures with a higher potential for postoperative complications to evaluate a possible reduction of their impact due to earlier recognition. Moreover, smaller gadgets and mobile phones could be utilized. CLINICALTRIAL Nil

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Day case hernia repair: weak evidence or practice gap?

Cited by 16 publications

References 30 publications

Clinical outcomes of ambulatory surgical treatment of unilateral inguinal hernia

Clinical outcomes of ambulatory surgical treatment of unilateral inguinal hernia

Trocar umbilical hernia repair by open suture repair and open suture–mesh repair in an ambulatory setting in comparison to recurrent and primary umbilical hernia repair

Perioperative Tablet-Based Telemonitoring After Abdominal Wall Hernia Surgery: Pilot Prospective Observational Cohort Study (Preprint)

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