Influence of learning curve and surgeon experience on postoperative pain after laparoscopic treatment of inguinal hernias.

INTRODUCTION: Laparoscopic approach for inguinal hernia offers considerable advantages. Several risk factors for postoperative pain have been investigated, but few articles can be found about learning curve and surgeon's influence on postoperative pain after inguinal herniorrhaphy. PATIENTS AND METHODS: A prospective study was conducted including 105 patients. Surgical procedures were performed by two general surgeons performing TAPP procedure. Follow up was realized at one and three months after surgery. RESULTS: Majority of investigated data were without significant differences. In case of the Senior Surgeon we registered higher SEI (surgeon experience index), increased proportion of bilateral inguinal hernias (P = 0.0309) and higher percentage of longer surgical procedures (P = 0.0309). Meantime in case of the Junior Surgeon we recorded operations with intermediate duration (P = 0.0232) in a greater manner. During the follow up period, similar incidence of pain senzation was remarked among patients, without statistical significance. CONCLUSION: With adequate learning program and supervision TAPP procedure can be a safe technique when performed by young specialist too, presenting similar postoperative results with those of experienced surgeons. KEY WORDS: Inguinal hernia, TAPP, Selfgripping surgical mesh, Postoperative pain.

A comparative analysis of three types of parathyroidectomies in renal hyperparathyroidism Single centre prospective cohort of 77 patients.

BACKGROUND: There is no consensus regarding optimal timing or best surgical procedure for refractory renal hyperparathyroidism patients. We aim to compare the results after three types of parathyroidectomies performed for sHPT in a single referral centre. METHODS: This study included patients on chronic hemodialysis submitted to three types of parathyroidectomy between 2010 and 2017. The primary outcome measure was relief of the symptoms and normalization of the main biochemical parameters. RESULTS: All symptoms improved significantly after surgery, especially osteoatricular pains. iPth dropped significantly immediately and during the follow up in all 3 groups; on short term, iPth values for group C(tPtx) were significantly lower compared to the other 2 subgroups (p=0.009). Furthermore, 5 patients from group C presented iPth values <12 pg/ml one year post-surgery, though this values tend to improve after. Patients from group B and C developed most often acute postoperative hypocalcemia, and persistent hyperparathyroidism was encountered especially after sPtx(10.3%). CONCLUSION: Significant improvement of both symptoms and biochemical parameters was noted in the majority of cases, regardless the parathyroidectomy type. tPtx is frequently followed by chronic hypoparathyroidism and subtotal parathyroidectomy is followed by a higher number of persistent and recurrent sHPT. KEY WORDS: Secondary hyperparathyroidism, Parathyroidectomy, Parathyroid autotransplant.