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1.
Medicine (Baltimore) ; 99(33): e21669, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872032

RESUMO

BACKGROUND: Whether regional anesthesia (RA) offers better long-term neurodevelopment outcomes compared to general anesthesia (GA) to infants undergoing inguinal herniorrhaphy is still under heated debate. The aim of this meta-analysis is to compare the long-term neurodevelopment impact of RA with GA on infants undergoing inguinal herniorrhaphy. METHODS: A systematic search of MEDLINE, EMBASE, PubMed, the Cochrane Central Register of Controlled Trials, clinicaltrials.gov and controlledtrials.com will be performed. Published eligible randomized controlled trials (RCTs) or quasi-RCTs (including abstracts) through May 20, 2020 with language limit of English will be enrolled in the meta-analysis. Two reviewers will independently conduct the procedures of study selection, data extraction, methodological quality assessment, and risk of bias assessment. The primary outcome is long-term neurodevelopmental state (at 2- and 5-year follow-up) as reflected in the Bayley and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) scales of infants development following surgeries. The secondary outcomes consist of satisfactory intraoperative infants immobility, duration of surgery, any anesthetic failure, the supplement of postoperative analgesia, postoperative apnea, and postoperative bradycardia. The pooled weighted mean differences (WMDs) or odds ratios (ORs) of each outcome measurement and relative 95% confident intervals (CIs) will be calculated. EndNote X8 (Clarivate Analytics) software will be applied to manage all citations. The Cochrane Review Manager version 5.3 software (RevMan 5.3) will be employed for statistical analysis. DISCUSSION: This study will summarize scientific and practical evidence and provide evidence-based individualized decision-making guidance on anesthesia regimen for inguinal herniorrhaphy in infants. REGISTRATION: This protocol was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 17 June 2020 (registration number INPLASY202060064).


Assuntos
Anestesia por Condução/efeitos adversos , Anestesia Geral/efeitos adversos , Cognição/efeitos dos fármacos , Herniorrafia/métodos , Desenvolvimento Infantil , Pré-Escolar , Hérnia Inguinal/cirurgia , Humanos , Lactente , Recém-Nascido , Metanálise como Assunto , Revisões Sistemáticas como Assunto
2.
Medicine (Baltimore) ; 99(33): e21557, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872005

RESUMO

PURPOSE: The aim of this study was to compare the effectiveness between laparoscopic herniorrhaphy (LH) and open herniorrhaphy (OH) in children with inguinal hernia. METHODS: PubMed, EmBase, and the Cochrane library were searched to select trials from their inception till April 2019. The summary of relative risks (RRs) and weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were employed to evaluate the treatment effectiveness between LH and OH. RESULTS: Six randomized controlled trials (RCTs) including a total of 594 children were selected. No significant differences were observed between LH and OH regarding the risk of postoperative complications. However, LH significantly reduced the risk of major postoperative complications when compared with OH. Moreover, LH showed association with a shorter operative time in bilateral inguinal hernia when compared with OH, whereas no significant difference between groups for unilateral inguinal hernia. Finally, children who received LH showed association with longer time to discharge than those who received OH, whereas no significant difference was observed between the groups for time to resume full activity. CONCLUSIONS: These findings suggested that children who received LH had protection against major postoperative complications than those who received OH. Moreover, children who received LH had shorter operative time, and longer time to discharge.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
BMC Surg ; 20(1): 190, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847559

RESUMO

BACKGROUND: Novel coronavirus pneumonia (NCP) outbreak in Wuhan, China in early 2020, resulted in over 80 thousand infections in China. At present, NCP has an explosive growth in the world. Surgeons could refuse selective operation during the outbreak, but they must face the emergency operation. We hope to avoid the spread of NCP while ensuring efficient treatment of emergency cases. METHODS: The data of patients with incarcerated hernia admitted to Beijing Chaoyang Hospital during NCP epidemic were analyzed and compared with those in 2019. All cases were divided into NCP group and 2019 group. The operation data and inpatient protection process of emergency cases were analyzed. Result During the NCP epidemic, 17 cases with incarcerated hernia were treated in our department. A Total of 263 cases of the same disease were admitted in 2019. There was no significant difference in age, gender, BMI and hernia type between two groups. No significant difference was observed between the two groups in operation method and hospital stay. The waiting time for emergency operation of NCP group was significantly longer than that of 2019 group (P = 0.002). A buffer ward was set up by administrator of hospital during NCP outbreak. Hospitals were divided into "Red area, Yellow area and Green area" artificially, and strict screening consultation system was implemented. There was no case of SARS-nCoV-2 infection in medical staff. CONCLUSION: It was safe and effective to carry out emergency operation on the premise of screening, protection and isolation during the NCP epidemic. The increased waiting time for operation due to NCP screening did not threaten medical safety of emergency incarcerated hernia patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Hérnia Abdominal/cirurgia , Herniorrafia , Hospitais Gerais , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Emergências , Serviço Hospitalar de Emergência , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 99(34): e21787, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846810

RESUMO

Laparoscopic inguinal herniorrhaphy has been well established for the management of primary and recurrent inguinal hernias. Single-incision laparoscopic surgery (SILS) has now been accepted as a less invasive alternative to conventional laparoscopic surgery. However, commercially available access devices for SILS had disadvantages such as rigidness and crowding. This series aimed to analyze the feasibility and safety of single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty (SILS-TAPP) by applying our self-made device for managing inguinal hernia.We collected and reviewed the medical records of patients who received SILS-TAPP using a self-made glove-port device between January 2014 and January 2016. All operations were performed by the same surgical team. The demographics and intra- and perioperative outcomes were evaluated.SILS-TAPP was successfully performed in 105 patients (131 inguinal hernia repairs). No major intra- and postoperative morbidities were encountered, and no conversion to a conventional 3-port approach or open surgery was required. The mean operative time was 73.5 min and the mean postoperative hospital stay was 2.1 days. Three minor short-term complications were noted, which were resolved without surgical intervention. One recurrence was diagnosed during follow-up and treated using a second TAPP procedure.SILS-TAPP was shown to be a feasible, safe procedure in patients with an inguinal hernia. A simple self-made glove-port device was proven as a practical method of SILS-TAPP.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/instrumentação , Laparoscopia/instrumentação , Adulto , Idoso , Estudos de Viabilidade , Feminino , Luvas Cirúrgicas , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Umbigo/cirurgia
5.
Medicine (Baltimore) ; 99(30): e21517, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791767

RESUMO

INTRODUCTION: Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary hypertension. It is often underdiagnosed or misdiagnosed as idiopathic pulmonary arterial hypertension (PAH). Inappropriate treatment may cause worsening of symptoms which may lead to fatal outcomes. Anesthetic considerations and management for pulmonary hypertension are well described, but few anesthesiologists are aware of the entity of PVOD and its management. PATIENT CONCERNS: We report a case of PVOD in a 73-year-old female who was on concurrent aspirin and anagrelide, requiring emergent open femoral hernia repair. DIAGNOSIS: PVOD and incarcerated femoral hernia INTERVENTION:: Combined spinal-epidural (CSE) was performed to enable the surgery. OUTCOME: Surgery was completed successfully under central neuraxial anesthesia and the patient remained stable and comfortable throughout, avoiding the need for general anesthesia. Due to the concurrent aspirin and anagrelide therapy, significant bleeding from the CSE puncture site was observed immediately post-operatively. This was resolved with external manual compression and withholding the aspirin and anagrelide. Patient remained well without neurological deficit and was discharged postoperative day seven. LESSONS: It is important to differentiate PVOD from PAH due to the controversial use of pulmonary vasodilators in PVOD. Pulmonary vasodilator is commonly used to treat acute pulmonary hypertension in PAH but its usage may lead to pulmonary edema in patients with PVOD. Hence, with no ideal treatment available, the avoidance of general anesthesia is crucial to prevent acute pulmonary hypertensive crisis in patient with PVOD. However, this needs to be weighed against the elevated risk of central neuraxial bleeding when performing a CSE in a patient on concurrent aspirin and anagrelide therapy. Calculated decision-making considering the risks and benefits of all alternatives should be carried out in such a scenario, and measures should be taken in anticipation of the potential consequences of the eventual decision. CONCLUSION: It is important to differentiate PVOD from PAH. PVOD has unique anesthetic considerations due to the controversial use of pulmonary vasodilators. This case also emphasizes the importance of active anticipation of potential issues and adequate follow up.


Assuntos
Anestesia Epidural , Raquianestesia , Complicações Intraoperatórias/prevenção & controle , Pneumopatia Veno-Oclusiva/complicações , Idoso , Feminino , Hérnia Femoral/cirurgia , Herniorrafia , Humanos , Complicações Intraoperatórias/etiologia
6.
Rev Col Bras Cir ; 47: e20202438, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32844913

RESUMO

OBJECTIVE: to compare hospital costs and clinical outcomes in inguinal and incisional hernioplasty before and after implementation of the ACERTO project in a university hospital. METHODS: retrospective study of 492 patients undergoing either inguinal hernioplasty (n=315) or incisional hernioplasty (n=177). The investigation involved two phases: between January 2002 and December 2005, encompassing cases admitted before the implementation of the ACERTO protocol (PRE-ACERTO period), and the other phase, with cases operated between January 2006 and December 2011, after the implementation of the protocol (ACERTO period). The main outcome variable was the comparison of the mean hospital costs between the two periods. As secondary endpoints, we analyzed the length of stay, the surgical site infection rate and mortality. We used the cost method suggested by Public Sector Cost Information System. RESULTS: surgical site infection was higher (p = 0.039) in the first phase of the study for both inguinal hernia operations (2 (1.6%) versus 0 (0%) cases) and incisional hernioplasty (5 (7.6%) versus 3 (2.7%) cases). The length of stay decreased one day after the implementation of the ACERTO protocol (p=0.005). There was a reduction in costs per patient from R$ 4,328.58 per patient in the first phase to R$ 2,885.72 in the second phase (66.7% reduction). CONCLUSION: there was a reduction in infectious morbidity, length of stay and hospital costs in hernioplasty after the implementation of the ACERTO protocol.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/economia , Análise Custo-Benefício , Custos Hospitalares , Humanos , Tempo de Internação , Estudos Retrospectivos , Resultado do Tratamento
7.
Khirurgiia (Mosk) ; (7): 39-44, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736462

RESUMO

OBJECTIVE: To evaluate an effectiveness of light strengthened polypropylene endoprosthesis in the treatment of patients with middle and large ventral hernias. MATERIAL AND METHODS: Early and long-term outcomes of surgical treatment were analyzed in 60 patients with middle and large ventral hernias. Onlay hernia repair was performed. Patients were divided into two groups by 30 patients. Abdominal wall repair with conventional polypropylene endoprosthesis was performed in the first group, light strengthened endoprosthesis was used in the second group. RESULTS: Application of light strengthened polypropylene endoprosthesis was accompanied by reduced inflammatory response and higher intensity of reparative processes in the area of implantation in early postoperative period. Moreover, we observed better functional state of abdominal rectus muscles in long-term postoperative period in the same group. Improved physical component of health by 4.5% was found in the 2nd group. As a result, incidence of excellent outcomes increased by 13.3%, good results by 6.7%, incidence of satisfactory results decreased by 20%. Recurrent hernia was absent. CONCLUSION: Light strengthened endoprosthesis is effective and advisable in patients with middle and large ventral hernia.


Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas , Materiais Biocompatíveis , Herniorrafia/instrumentação , Humanos , Luz , Masculino , Polipropilenos , Próteses e Implantes , Recidiva
8.
Rev Med Suisse ; 16(699): 1300-1304, 2020 Jul 01.
Artigo em Francês | MEDLINE | ID: mdl-32608587

RESUMO

Ventral hernia surgery has undergone major changes over the past decade with the emergence of new minimally invasive techniques. They merge fundamental concepts of parietal reconstruction of open surgery into a laparoscopic approach, aiming to reduce surgical site complications and to enhance recovery. The spread of robotic assistance systems in the field of abdominal wall surgery facilitates access to this type of procedures and allows their application in increasingly complex cases. Parietal relaxation techniques allow large hernial orifices to be closed without tension. They are now also performed with a minimally invasive approach and in a less aggressive manner. Even if the exact place of all these techniques still needs to be better defined depending on the different hernia types, these laparoscopic or robot-assisted approaches already tend to allow faster post-operative recovery.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Humanos
9.
Rev Med Suisse ; 16(699): 1305-1309, 2020 Jul 01.
Artigo em Francês | MEDLINE | ID: mdl-32608588

RESUMO

Groin hernia in women is an entity whose clinical manifestations can be quite subtle, and which therefore risks to go unnoticed. Imaging studies by ultrasound or dynamic CT/MRI is strongly recommended in case of a clinical doubt. Optimal treatment consists of laparoscopic surgery, even in oligosymptomatic patients, because the risk of incarceration, and subsequent morbidity and mortality is high especially in cases of femoral hernia, which are frequent and often overlooked in women. During pregnancy, the risk of developing a groin hernia is very low (around 0,1%) and a wait-and-see attitude is to be preferred as much as possible, except in the case of an acute complication (incarceration).


Assuntos
Virilha/cirurgia , Hérnia Femoral/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia , Feminino , Virilha/diagnóstico por imagem , Hérnia Femoral/diagnóstico por imagem , Hérnia Inguinal/diagnóstico por imagem , Humanos , Laparoscopia , Gravidez , Fatores Sexuais , Ultrassonografia
10.
Med Glas (Zenica) ; 17(2): 275-278, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32662615

RESUMO

Aim The outbreak of the COVID-19 pandemic has had a major impact on the delivery of elective, as well as emergency surgery on a world-wide scale. Up to date few studies have actually assessed the impact of COVID-19 on the postoperative morbidity and mortality following emergency gastrointestinal surgery. Herein, we present our relevant experience over a 3-month period of uninterrupted provision of emergency general surgery services in George Eliot Hospital NHS Trust, the United Kingdom. Methods We performed a retrospective analysis of a prospective institutional database, which included the operation types, paraclinical investigations and postoperative complications of all patients undergoing emergency general surgery operations between March - May 2020. Results The occurrence of a 5% overall respiratory complication rate postoperatively, with 3% infection rate for COVID-19 was found; no patient had unplanned return to intensive care for ventilator support and there was no mortality related to COVID-19 infection. Conclusion When indicated, emergency surgery should not be delayed in favour of expectant/conservative management in fear of COVID-19-related morbidity or mortality risks.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório , Emergências , Mortalidade , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Insuficiência Respiratória/epidemiologia , Infecções Respiratórias/epidemiologia , Abscesso/cirurgia , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Betacoronavirus , Colecistectomia Laparoscópica , Comorbidade , Infecções por Coronavirus/terapia , Surtos de Doenças , Drenagem , Feminino , Herniorrafia , Humanos , Laparoscopia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/epidemiologia , Insuficiência Respiratória/terapia , Infecções Respiratórias/terapia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
11.
Am Surg ; 86(5): 437-440, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684023

RESUMO

BACKGROUND: Opioid overuse is a concern in adult and pediatric populations. Physician education may improve appropriate opioid prescribing and patient instruction for use. Prescribing and use of opioid for pain control after pediatric umbilical hernia repair (UH) before and after surgeon education was evaluated. This is a substudy of a multi-institutional study assessing prescribing practice before and after surgeon education. This study further assessed patient prescription filling pattern and parent report of pain control. METHODS: A retrospective study was performed evaluating children who underwent UH 6 months before and after an educational presentation on opioid use. Prescriptions, prescription fills, patient medication use, and pain control effectiveness were assessed. Adverse events were collected. RESULTS: There were 78 subjects in the pre- and 99 in the posteducation group. Opioid prescribed changed from 98.7% to 61.6% (P < .0001), and nonopioid prescriptions increased following education (P = .0063). The number of opioid prescriptions filled decreased (P = .0296). There were limited data on opioid doses used and quality of pain control, but the posteducation group showed good pain control. There was no difference in adverse events. DISCUSSION: Surgeon education on current opioid epidemic and strategies for opioid stewardship improves opioid prescribing and use without adversely impacting pain control or clinical outcome.


Assuntos
Analgésicos Opioides/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Cirurgia Geral/educação , Hérnia Umbilical/cirurgia , Herniorrafia , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos
12.
Rev Assoc Med Bras (1992) ; 66(5): 687-691, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32638972

RESUMO

OBJECTIVE To compare Mesh-plug, Lichtenstein, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) repairs in regards to operation time, seroma, infection, and recurrence of inguinal hernia repair. METHODS Relevant literature was searched in the Cochrane Library, Pubmed, and Embase. Furthermore, the analysis of randomized controlled studies (RCTs) was performed using methods recommended by the Cochrane Collaboration. The main outcomes including operation time, seroma, infection, and recurrence were evaluated. RESULTS A total of 38 RCTs with 3255 patients were included in the meta-analysis. In addition, the comparison between Mesh-plug, Lichtenstein, TAPP, and TEP showed the differences were not significant regarding operation time, seroma, infection, and recurrence. CONCLUSIONS Meta-analysis suggests that Mesh-plug, Lichtenstein, TAPP, and TEP are comparable in the outcomes of hernia repair, such as operation time, seroma, infection, and recurrence.


Assuntos
Hérnia Inguinal , Laparoscopia , Telas Cirúrgicas , Herniorrafia , Humanos , Metanálise em Rede , Recidiva , Resultado do Tratamento
13.
Rev Assoc Med Bras (1992) ; 66(5): 623-629, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32638974

RESUMO

INTRODUCTION Abdominal wall hernias are a highly prevalent pathology, considering that 55 percent of the world population is affected by this disease at some point in their lives. As a large part of these patients present comorbidities, it is important to correlate the incidence of complications with the presence of previous pathologies. OBJECTIVES To evaluate whether the presence of comorbidities in patients submitted to inguinal hernioplasty increases the risk of acute and chronic complications in the postoperative period, as well as to explain which of these prior diseases present a greater association with the incidence of complications. METHODS This is a cross-sectional descriptive study carried out through the retrospective analysis of 313 medical records of patients submitted to open inguinal hernioplasty surgery between March and June 2017 at the General Surgery Service of the Cruz Vermelha Hospital - Paraná Branch, located in the City of Curitiba, state of Paraná, Brasil. RESULTS Of the 313 cases studied, the most prevalent comorbidities were: 107 patients with hypertension (34.19%), 52 smokers (16.61%), 30 cases with diabetes (9.58%), 14 with hypothyroidism (4,47%) and 10 with COPD (3.19%). Regarding the total of the sample evaluated, 130 patients (41.53%) did not present any comorbidity. When evaluating the complications, there were 49 cases (15.65%) of complications in the early postoperative period and 9 cases (2.88%) of chronic complications. The comorbidities that presented significant statistical influence (p <0.05) on the incidence of acute complications were hypertension (p = 0.02927) and smoking (p = 0.03196). CONCLUSION It is important to note the presence of acute postoperative complications of inguinal hernioplasty in patients who have hypertension or smoke, high prevalence diseases.


Assuntos
Hérnia Inguinal , Laparoscopia , Brasil , Estudos Transversais , Herniorrafia , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco
14.
PLoS One ; 15(7): e0235899, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649688

RESUMO

BACKGROUND: In the literature, no studies describe the use of laparoscopic techniques for inguinal hernia repair in canine clinical patients. The surgical technique-Percutaneous Internal Ring Suturing (PIRS) presented in this article is the world's first minimally invasive laparoscopic surgical technique for inguinal canal closure in dogs. AIM: The aim of the presented study is to evaluate the possibility of employment of the laparoscopic PIRS technique in clinical practice as well as to technically evaluate its usefulness in the treatment of the inguinal hernia in dogs. The presented study describes the procedure and the results of laparoscopic treatment of 11 inguinal hernias in nine dogs (two bilateral). METHODS: The whole procedure is performed under camera control introduced through one umbilical trocar. The very closure of the inner inguinal ring is done with the injection needle by a small puncture over the inguinal canal with the help of which the suture material is inserted, and the canal of the operated inguinal hernia is closed. Each operated dog underwent a thorough clinical examination before surgery which was combined with ultrasound examination of the inguinal canals before, immediately after and three months after surgery. RESULTS: There was no hernia recurrence in the study period in the operated dogs and all individuals returned to full mobility immediately after recovery from anesthesia. CONCLUSIONS: Due to the low invasiveness and simplicity of performance, the PIRS technique described in the study should be taken into account when choosing a treatment method for non-traumatic inguinal hernia in dogs. At the same time, the possibility of using the described technique in other types of inguinal hernia in dogs requires further research.


Assuntos
Doenças do Cão/cirurgia , Hérnia Inguinal/veterinária , Técnicas de Sutura/veterinária , Animais , Cães , Feminino , Hérnia Inguinal/cirurgia , Herniorrafia/veterinária , Canal Inguinal/cirurgia , Laparoscopia/veterinária , Masculino
16.
Niger J Clin Pract ; 23(7): 897-899, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620716

RESUMO

Background: The most important advantages of laparoscopic hernia repair include less postoperative pain, good cosmetic results, and early return to daily activities. Different methods and mesh types are used in inguinal hernia repair. Aims: The objective of this study was to evaluate the complications and recurrence rates in patients who underwent laparoscopic inguinal hernia repair with and without mesh fixation. Subjects and Methods: A total of 183 patients who underwent total extraperitoneal (TEP) inguinal hernia repair in the general surgery clinic between January 2012 and January 2015 patients operated due to inguinoscrotal hernia and those lost to follow-up were excluded from the study. Patients were divided into two groups. Group 1 consisted of patients in whom 3D (Bard 3D Max) mesh was used and fixed with symphysis pubis absorbable tucker, while group 2 included patients without mesh fixation. All statistical analyses were performed using SPSS 22.0 statistical package software. The differences were considered statistically significant if the P value was less than 0.05. Results: In the study, 178 patients were included. The median age was 48 years. Of all patients, 98 had right-sided, 72 left-sided, and eight bilateral hernias. The mean follow-up duration was 45 months. The demographic data between the groups were similar. Operation time was 51.82 ± 18.87 min in group 1 and 52 ± 19.92 in group 2 (P = 0.089). No statistically significant difference was found between both groups in terms of the development of early and late complications. Intraoperative complications, port-site hernia, and mortality were not seen in any patient. Conclusion: TEP seems to be a safe and effective surgical approach in inguinal hernia treatment with acceptable operation times and postoperative results. It was determined that not performing mesh fixation in the TEP application did not cause a statistical increase in morbidity and recurrence rates.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Próteses e Implantes/efeitos adversos , Recidiva , Resultado do Tratamento
18.
BMC Surg ; 20(1): 147, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631293

RESUMO

BACKGROUND: Chronic postsurgical pain (CPSP) after hernia repair research has mainly relied on unconfirmed self-reporting. We aimed to describe confirmed CPSP incidence, management, and quality of life (QoL) in a 2-year prospective study. METHODS: Multicenter study (GENDOLCAT) of 3890 patients undergoing 4 common surgical procedures in 23 hospitals to develop a risk model for CPSP; 2352 men underwent open hernia repair. Patients with pain were identified by telephone at 1 and 3 months and referred to the hospital 4 months after surgery for a physical examination to confirm CPSP. Three validated tools were used: the Brief Pain Inventory (BPI) for severity, analgesic use, and interference with activities; the SF-12 questionnaire for QoL (validated Spanish version), and the Douleur Neuropathique 4 (DN4). Patients with CPSP were called again at 1 and 2 years. RESULTS: In 1761 patients who underwent hernia repair and were eligible for physical examination for CPSP, the incidence of confirmed pain at 4 months was 13.6% (patient-reported pain, 6.2% at 1 year and 4.0% at 2 years). Neuropathic pain was diagnosed in 38.5% of the CPSP patients at 4 months. The incidences of neuropathic CPSP in patients with mesh or non-mesh repairs were similar (38.6 and 33.3%, respectively). SF-12 physical component scores changed little in all patients, whether or not they developed CPSP. The SF-12 mental component decreased significantly in all patients, but the decrease was clinically significant only in CPSP patients. CPSP interfered with activities (18%), work (15.6%), walking (15%) and mood (10.2%). At 2 years 52.1% of CPSP patients had moderate/intense pain and 28.2% took analgesics. CONCLUSION: CPSP affects QoL-related activities, and although it diminishes over the course of 2 years after surgery, many patients continue to have moderate/intense pain and take analgesics. CPSP and neuropathic pain rates seem to be similar after mesh and non-mesh repair. BPI and SF-12 mental component scores detect effects on QoL. TRIAL REGISTRATION: ClinicalTrials.gov NCT01510496.


Assuntos
Dor Crônica/etiologia , Herniorrafia/métodos , Dor Pós-Operatória/etiologia , Qualidade de Vida , Adulto , Idoso , Analgésicos/administração & dosagem , Virilha/cirurgia , Hérnia Inguinal/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Estudos Prospectivos , Inquéritos e Questionários
19.
Int J Surg ; 80: 157-161, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32679205

RESUMO

BACKGROUND: during the COVID-19 pandemic, the number of Acute Care Surgery procedures performed in Spanish hospitals decreased significantly. The aim of this study was to compare Acute Care Surgery activity during the COVID-19 pandemic and during a control period. MATERIAL AND METHODS: a multicenter retrospective cohort study was performed including patients who underwent Acute Care Surgery in three tertiary care hospitals in Spain during a control (11th March 2019 to 21st April 2019) and a pandemic (16th March 2020 to 26th April 2020) period. Type of surgical procedures, patients' features and postoperative complications were compared. RESULTS: two hundred and eighty-five and 117 patients were included in each group. Mean number of patients who underwent Acute Care Surgery during the control and pandemic periods was 2.3 and 0.9 patients per day and hospital (p < 0.001), representing a 58.9% decrease in Acute Care Surgery activity. Time from symptoms onset to patient arrival at the Emergency Department was longer during the pandemic (44.6 vs. 71.0 h, p < 0.001). Surgeries due to acute cholecystitis and complications from previous elective procedures decreased (26.7% vs. 9.4%) during the pandemic, while bowel obstructions and abdominal wall hernia surgeries increased (12.3% vs. 22.2%) (p = 0.001). Morbidity was higher during pandemic period (34.7% vs. 47.1%, p = 0.022), although this difference was not statistically significant in the multivariate analysis. Reoperation rate (17.9% vs. 12.8%, p = 0.212) and mortality (6.7% vs. 4.3%, p = 0.358) were similar in both groups. CONCLUSION: during the COVID-19 pandemic, a significant reduction in the performance of Acute Care Surgery procedures was observed. Moreso, a longer time from symptoms onset to patient arrival at the Emergency Department was noted. Higher morbidity was observed in patients undergoing Acute Care Surgery during the pandemic period, although there was not any difference in mortality or reoperation rate.


Assuntos
Abscesso/cirurgia , Apendicite/cirurgia , Colecistite Aguda/cirurgia , Infecções por Coronavirus/epidemiologia , Obstrução Intestinal/cirurgia , Mortalidade , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Doenças Retais/cirurgia , Parede Abdominal , Abscesso/epidemiologia , Doença Aguda , Apendicectomia/estatística & dados numéricos , Apendicite/epidemiologia , Betacoronavirus , Colecistite Aguda/epidemiologia , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Emergências , Feminino , Hérnia Abdominal/epidemiologia , Hérnia Abdominal/cirurgia , Herniorrafia/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Obstrução Intestinal/epidemiologia , Laparoscopia/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Pandemias , Doenças Retais/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Espanha/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos
20.
BMJ ; 370: m2457, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32665218

RESUMO

OBJECTIVE: To determine whether robotic ventral hernia repair is associated with fewer days in the hospital 90 days after surgery compared with laparoscopic repair. DESIGN: Pragmatic, blinded randomized controlled trial. SETTING: Multidisciplinary hernia clinics in Houston, USA. PARTICIPANTS: 124 patients, deemed appropriate candidates for elective minimally invasive ventral hernia repair, consecutively presenting from April 2018 to February 2019. INTERVENTIONS: Robotic ventral hernia repair (n=65) versus laparoscopic ventral hernia repair (n=59). MAIN OUTCOME MEASURES: The primary outcome was number of days in hospital within 90 days after surgery. Secondary outcomes included emergency department visits, operating room time, wound complications, hernia recurrence, reoperation, abdominal wall quality of life, and costs from the healthcare system perspective. Outcomes were pre-specified before data collection began and analyzed as intention to treat. RESULTS: Patients from both groups were similar at baseline. Ninety day follow-up was completed in 123 (99%) patients. No evidence was seen of a difference in days in hospital between the two groups (median 0 v 0 days; relative rate 0.90, 95% confidence interval 0.37 to 2.19; P=0.82). For secondary outcomes, no differences were noted in emergency department visits, wound complications, hernia recurrence, or reoperation. However, robotic repair had longer operative duration (141 v 77 min; mean difference 62.89, 45.75 to 80.01; P≤0.001) and increased healthcare costs ($15 865 (£12 746; €14 125) v $12 955; cost ratio 1.21, 1.07 to 1.38; adjusted absolute cost difference $2767, $910 to $4626; P=0.004). Among patients with robotic ventral hernia repair, two had an enterotomy compared none with laparoscopic repair. The median one month postoperative improvement in abdominal wall quality of life was 3 with robotic ventral hernia repair compared with 15 following laparoscopic repair. CONCLUSION: This study found no evidence of a difference in 90 day postoperative hospital days between robotic and laparoscopic ventral hernia repair. However, robotic repair increased operative duration and healthcare costs. TRIAL REGISTRATION: Clinicaltrials.gov NCT03490266.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Serviço Hospitalar de Emergência , Herniorrafia/efeitos adversos , Herniorrafia/economia , Custos Hospitalares , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/economia , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias , Qualidade de Vida , Recidiva , Reoperação , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/economia
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