Open intraperitoneal mesh repair for umbilical hernias. A technical note.

BACKGROUND: Mesh techniques are the preferable methods for repair of small ventral hernias, including umbilical and epigastric hernias, as primary suture repair shows high recurrence rates. Recently, the Ventralex (Davol Inc., C.R.Bard, Inc., RI, USA) hernia patch was introduced with promising preliminary short-term results. METHODS: In this short technical note we describe both the surgical technique for adequate patch placement and the material characteristics of this device with associated pro's and con's. CONCLUSION: For small ventral hernia repair the Ventralex patch is a very elegant and quick to use mesh device. Although it is meant to be used intraperitoneally, it is also possible to place the patch in the preperitoneal space. However, probably due to the less controllable mesh deployment, and the interaction between the different materials, especially in the preperitoneal space, extra attention and some caution during placement is warranted using this device.

Outpatient laparoscopic cholecystectomy in Belgium: what are we waiting for?

BACKGROUND: The current advances and expertise in minimally invasive surgery and the present importance of cost containment have encouraged the performance of laparoscopic cholecystectomy (LC) as an ambulatory procedure. A retrospective study was carried out to assess the feasibility, outcome and patients' preference and satisfaction after performing true day-case LC in a university teaching hospital. METHODS: All patients admitted consecutively between January 2003 and March 2005 for LC were considered for inclusion in the study. Patients were offered ambulatory treatment if they were ASA class 1 or 2, had no clinical signs of acute cholecystitis or pancreatitis, and had a responsible carer at home. All others underwent a routine LC. Reasons for refusing day-surgery LC were analyzed. Postoperative complications, conversion rate, overnight stay and patient satisfaction were all evaluated. RESULTS: A total of 249 LCs were performed. Only 15 (6%) were performed in an ambulatory setting. Reasons for refusing day-surgery were medical (42%), doubt about reimbursement by insurance companies (15%) or psychological (49%). All patients were treated for symptomatic cholecystolithiasis. Unplanned admission was 13% because of excessive nausea and vomiting. Outpatient follow-up showed that overall patient satisfaction was over 80%. CONCLUSION: Considering an increasing trend towards reduced hospital stay, ambulatory LC is feasible and safe, showing high levels of patient satisfaction. Adequate prophylaxis of postoperative nausea, vomiting and pain management is necessary. However, the provision of adequate information to the patient by the referring physician is essential to avoid refusal of ambulatory treatment. Insurance companies have to be more liberal with their policies for day-case surgery.