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INTRODUCTION: Postoperative Ileus (POI) negatively impacts patient outcomes and increases healthcare costs. Transcutaneous electrical nerve stimulation (TENS) has been found to improve gastrointestinal (GI) motility following abdominal surgery. However, its effectiveness in this context is not well-established. This study was designed to evaluate the role of TENS on the recovery of GI motility after exploratory laparotomy. METHODS: Patients undergoing exploratory laparotomy were randomized in a 1:1 ratio into control (standard treatment alone) and experimental (standard treatment + TENS) arms. TENS was terminated after 6 days or after the passage of stool or stoma movement. The primary outcome was time for the first passage of stool/functioning stoma. Non-passage of stool or nonfunctioning stoma beyond 6 days was labeled as prolonged POI. Patients were monitored until discharge. RESULTS: Median (interquartile range) time to first passage of stool/functioning stoma was 82.6 (49-115) hours in the standard treatment group and 50 (22-70.6) hours in the TENS group [p < 0.001]. Prolonged POI was noted in 11 patients in the standard treatment group (35.5%) and one in the TENS group (3.2%) [p = 0.003]. Postoperative hospital stay was similar in the two groups. CONCLUSION: TENS resulted in early recovery of GI motility by shortening the duration of POI without any improvement in postoperative hospital stay. TRIAL REGISTRATION NUMBER: CTRI/2021/10/037054.
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BACKGROUND: Telemedicine is the use of electronic information to communicate technologies to provide and support healthcare when distance separates the participants. Satisfaction and engagement of patients are key resource indicators for any healthcare setup and healthcare provider for evolving the care continuum (a system that provides a comprehensive range of health services so that care can evolve with the patient over time) and ensuring continuous quality improvement in the systems. As the latest remarkable strategy to connect with patients for consultations and follow-up, telemedicine has been of pivotal importance, especially during the coronavirus disease 2019 (COVID-19), where medicinal services utilize digital sound, video, and information interchanges to remotely access and provide care. MATERIALS AND METHODS: A cross-sectional study was planned during the second wave of the COVID-19 pandemic from April 2021 to April 2022 to assess the impact of telemedicine in essential healthcare delivery by super specialty tertiary care healthcare setup, which is also a medical college, by three consultants and a physiotherapist. RESULTS: There was a significant improvement in satisfaction scores and an improvement in the approach of patients towards telemedicine was observed. Various other parameters, like readmission compliance with medications and a reduction in ED times, were also observed. Finally, clinical endpoints were captured, and the correlation between readmission and medicine adherence was found to be strongly correlated (r = 0.9). A p-value of the reduction in utilization times of ED (emergency department), readmission, and medicine adherence was found to be highly significant Conclusions: Telemedicine is the need of the hour and is now an essential part of healthcare. Its acceptance post-COVID-19 pandemic and adaptability into existing healthcare setups would deliver fruitful results.
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Background Ventral hernias are usually repaired by an open or laparoscopic approach. Quality of life after ventral hernia repair is a very important but often underestimated parameter. This prospective observational study was conducted to assess the quality of life and other related parameters after all types of ventral hernia repair, mainly between open and laparoscopic repairs. Objectives This study aimed to determine the quality of life after ventral hernia repairs. We also analysed and compared various parameters such as outcomes and satisfaction, postoperative pain, and complications between laparoscopic and open ventral hernia repair. Methods This was a hospital-based prospective observational study conducted from January 2020 to December 2021, which included a total of 70 patients with ventral hernias. Thirty-nine patients underwent open repair and 31 patients underwent laparoscopic repair. Demographic data and other data such as postoperative hospital stay, return to activity, postoperative pain, complications, and quality of life were collected and analysed. Results The distribution of different types of hernias observed in our study included 34% incisional hernias, 33% umbilical and paraumbilical hernias, and 33% epigastric hernias. The incidence of complications was significantly less in laparoscopic repair compared to open repair. Also, satisfaction at 1 month was significantly more in the laparoscopic group compared to the open group. However, there is no significant difference in the postoperative pain, postoperative hospital stay, return to activity, satisfaction at discharge, and quality of life at 1 month in both the laparoscopic and open repairs. Conclusion Laparoscopic ventral hernia repairs are associated with lesser complications and higher satisfaction. The use of tackers and trans-fascial sutures can significantly increase postoperative pain in laparoscopic repair and is the major factor affecting the short-term quality of life in laparoscopic repairs. As there is no difference in postoperative pain, hospital stay, and return to activity, laparoscopic repairs should be preferred wherever possible in view of fewer complications and higher satisfaction.
