LAPAROSCOPIC INGUINAL HERNIA REPAIR: THE LONG-TERM ASSESSMENT OF CHRONIC PAIN AND QUALITY OF LIFE.

BACKGROUND: Laparoscopic approaches to inguinal hernia repair include transabdominal extraperitoneal and transabdominal preperitoneal, both of which are widely performed and employ mesh. Indicators of success for these surgical procedures include incidence of complications, time to return to daily activities, incidence of postoperative chronic pain, and the long-term postoperative patient satisfaction. OBJECTIVE: This study aimed to evaluate and compare long-term postoperative incidence of chronic pain and overall quality of life among patients undergoing transabdominal extraperitoneal or transabdominal preperitoneal inguinal hernia repair. METHODS: This was a retrospective cross-sectional study. Medical records were analyzed, and the SF-36 questionnaire and Visual Analog Scale were applied to assess quality of life and chronic pain in patients undergoing laparoscopic inguinal hernia repair between January 2017 and February 2021. RESULTS: A total of 167 patients status post laparoscopic inguinal hernia repair, who were 3 months postoperatively or longer, were included in the study. Among the early complications seen, seroma was most common in the transabdominal preperitoneal group (p=0.04). Subsequently, 40 of the initial 167 patients answered to the survey instrument (SF-36 and Visual Analog Scale). Mean patient-reported pain (Visual Analog Scale score) was statistically similar between groups, with 1.29 for transabdominal preperitoneal and 1.68 for transabdominal extraperitoneal (p=0.92). In the domains evaluated by the SF-36, there was no significant difference between the samples. CONCLUSION: Both transabdominal extraperitoneal and transabdominal preperitoneal techniques for hernia repair have similar results in the late postoperative period regarding quality of life and prevalence of chronic pain. They are also comparable in terms of major early postoperative complications, except for seroma, with a higher incidence in patients undergoing transabdominal preperitoneal.

Laparoscopic inguinal hernia repair: the long-term assessment of chronic pain and quality of life / Herniorrafia inguinal laparoscópica: avaliação a longo prazo da dor crônica e qualidade de vida

ABSTRACT BACKGROUND: Laparoscopic approaches to inguinal hernia repair include transabdominal extraperitoneal and transabdominal preperitoneal, both of which are widely performed and employ mesh. Indicators of success for these surgical procedures include incidence of complications, time to return to daily activities, incidence of postoperative chronic pain, and the long-term postoperative patient satisfaction. OBJECTIVE: This study aimed to evaluate and compare long-term postoperative incidence of chronic pain and overall quality of life among patients undergoing transabdominal extraperitoneal or transabdominal preperitoneal inguinal hernia repair. METHODS: This was a retrospective cross-sectional study. Medical records were analyzed, and the SF-36 questionnaire and Visual Analog Scale were applied to assess quality of life and chronic pain in patients undergoing laparoscopic inguinal hernia repair between January 2017 and February 2021. RESULTS: A total of 167 patients status post laparoscopic inguinal hernia repair, who were 3 months postoperatively or longer, were included in the study. Among the early complications seen, seroma was most common in the transabdominal preperitoneal group (p=0.04). Subsequently, 40 of the initial 167 patients answered to the survey instrument (SF-36 and Visual Analog Scale). Mean patient-reported pain (Visual Analog Scale score) was statistically similar between groups, with 1.29 for transabdominal preperitoneal and 1.68 for transabdominal extraperitoneal (p=0.92). In the domains evaluated by the SF-36, there was no significant difference between the samples. CONCLUSION: Both transabdominal extraperitoneal and transabdominal preperitoneal techniques for hernia repair have similar results in the late postoperative period regarding quality of life and prevalence of chronic pain. They are also comparable in terms of major early postoperative complications, except for seroma, with a higher incidence in patients undergoing transabdominal preperitoneal.

RESUMO RACIONAL: Atualmente o tratamento da hérnia inguinal pode ser laparoscópico totalmente extraperitoneal ou transabdominal pré-peritoneal, ambas as técnicas utilizam tela e são amplamente empregadas. O sucesso do procedimento cirúrgico é medido pelo menor número de complicações, retorno rápido às atividades cotidianas, presença ou não de dor crônica e pelo grau de satisfação do paciente no pós-operatório. OBJETIVOS: Avaliar e comparar a presença de dor crônica e qualidade de vida no pós operatório tardio de pacientes submetidos às duas técnicas de cirurgias laparoscópicas de correção de hérnia inguinal. MÉTODOS: O estudo consistiu em uma abordagem quantitativa transversal retrospectiva. Foi realizada análise de prontuários e aplicação de questionário SF-36 e Escala Visual Analógica para avaliação de qualidade de vida e dor crônica em pacientes submetidos a hernioplastia inguinal laparoscópica entre janeiro de 2017 a fevereiro de 2021. RESULTADOS: Foram analisados 167 prontuários com mais de 3 meses de pós-operatório. Dentre as complicações precoces avaliadas, o seroma foi mais comumente diagnosticado no grupo transabdominal pré-peritoneal (p=0,04). Posteriormente, 40 dos 167 pacientes responderam ao instrumento de pesquisa composto por SF-36 e Escala Visual Analógica. A média para dor crônica, mensurada através da Escala Visual Analógica, foi de 1,29 para transabdominal pré-peritoneal versus totalmente extraperitoneal com 1,68 (p=0,92). Já nos domínios avaliados pelo SF-36 não houve diferença significativa entre as amostras (p>0,05). CONCLUSÕES: As técnicas totalmente extraperitoneal e transabdominal pré-peritoneal apresentam resultados semelhantes no pós-operatório tardio com base na qualidade de vida e dor crônica. As técnicas também são comparáveis em termos das principais complicações pós-operatórias precoces, exceto para seroma, que apresentou maior incidência em pacientes submetidos a transabdominal pré-peritoneal.

The "Hug" Technique-Roux-en-Y Gastric Bypass with Preservation of the Posterior Wrap in Patients with Previous Nissen Fundoplication: a Simple Solution for a Complex Problem.

BACKGROUND: Laparoscopic conversion of Nissen Fundoplication to Roux-en-Y gastric bypass (RYGB) is a complex procedure due to increased operative time, morbidity, and length of hospital stay (LOS). In this study, a new simplified technique avoiding the total dismantling of the previous Nissen repair to construct the gastric pouch, the so-called hug technique is presented for the conversion of Nissen fundoplication to RYGB. METHODS: The present study is a prospective single-center clinical series reporting on the feasibility and safety of the "hug" technique for the creation of laparoscopic RYGB. The major innovation of this approach is the fact that the posterior part of the fundoplication wrap is left in place without further dissection or manipulation. The anterior part is stapled and remains attached to the excluded stomach. Prospective data on intraoperative and postoperative morbidity and bariatric outcomes were collected. RESULTS: A total of 44 consecutive patients with a mean body mass index (BMI) of 43.7 kg/m2 (SD = 4.0, range = 35.6-52.0) underwent the "hug" procedure between 2004 and 2015. Mean operative time was 72 min (58-105 min). Morbidity was 4.5%, with no mortality. For patients with follow-up at 3 years, the percentage of total body weight loss (%TBWL) was 32.5%; the excess weight loss (EWL) was 64.2%. CONCLUSION: In contrast to current other techniques of bariatric surgery for patients having previously undergone a Nissen fundoplication, the "hug" procedure to create an RYGB is safe and simple to perform. This technique avoids the deconstruction of the previous repair and is still maintaining anti-reflux anatomy. Nevertheless, there is a need for further studies to evaluate the long-term outcomes of the procedure.

Acute abdomen after abdominoplasty: differential diagnosis.

UNLABELLED: Abdominoplasty is a very common elective procedure in plastic surgery. Surgical accidents can lead to serious complications that result in an acute surgical abdomen, but in rare cases, an acute surgical abdomen not related to the procedure develops. This report discusses the diagnostic approach for patients with an acute abdomen after abdominoplasty and presents a case of appendicitis in the immediate postoperative period. The importance of postoperative follow-up evaluation by the same surgeon who performed the procedure is discussed as well as the need for adequate general surgery training to obtain the correct diagnosis and perform the urgent operation required to avoid a detrimental outcome. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Appendectomy. Comparative study between a public and a private hospital.

OBJECTIVE: The aim of this study is to compare data of patients submitted to appendectomy for acute appendicitis at a public hospital and at a private hospital. METHODS: A total of 200 medical records of patients submitted to appendectomy for acute appendicitis at a public hospital (n=100) and at a private hospital (n=100), was reviewed retrospectively. RESULTS: Mean age and gender distribution were similar for patients of both hospitals. More patients had been previously evaluated by other physicians in the group of the public hospital (n=85) than of the private hospital (n=13) (p< 0.0001). Ultrasonography was performed more frequently on patients of the public hospital (n=56) than of the private hospital (n=30) (p=0.0002). Length of hospital stay was longer at the public hospital (3.5 ± 2.8 days) than at the private hospital (2.5 ± 1.7 days) (p=0.0024). Postoperative complications were more frequent at the public hospital (n=36) than at the private hospital (n=20) (p<0.0117). Time to resume routine activities was longer for the public hospital (33.2 ± 8.3 days) than for the private hospital (16.4 ± 5.2 days) (p<0.0001). Multivariate logistic-regression analysis showed that the estimated probability of complicated appendicitis increased with the time interval between onset of symptoms and appendectomy (p<0.001). Independent risk factor associated with complicated appendicitis was the time interval between onset of symptoms and appendectomy (odds ratio 41.65, 95% CI {confidence interval} 2.90-597.49, p<0.0001) at the public hospital. There was no independent risk factor associated with complicated appendicitis at the private hospital. CONCLUSION: There are important differences between public and private hospitals in the diagnosis and outcomes of patients with acute appendicitis submitted to appendectomy.

Appendectomy: comparative study between a public and a private hospital / Apendicectomia: estudo comparativo retrospectivo entre um hospital público e um privado

OBJECTIVE: The aim of this study is to compare data of patients submitted to appendectomy for acute appendicitis at a public hospital and at a private hospital. METHODS: A total of 200 medical records of patients submitted to appendectomy for acute appendicitis at a public hospital (n=100) and at a private hospital (n=100), was reviewed retrospectively. RESULTS: Mean age and gender distribution were similar for patients of both hospitals. More patients had been previously evaluated by other physicians in the group of the public hospital (n=85) than of the private hospital (n=13) (p< 0.0001). Ultrasonography was performed more frequently on patients of the public hospital (n=56) than of the private hospital (n=30) (p=0.0002). Length of hospital stay was longer at the public hospital (3.5±2.8 days) than at the private hospital (2.5±1.7 days) (p=0.0024). Postoperative complications were more frequent at the public hospital (n=36) than at the private hospital (n=20) (p<0.0117). Time to resume routine activities was longer for the public hospital (33.2±8.3 days) than for the private hospital (16.4±5.2 days) (p<0.0001). Multivariate logistic-regression analysis showed that the estimated probability of complicated appendicitis increased with the time interval between onset of symptoms and appendectomy (p<0.001). Independent risk factor associated with complicated appendicitis was the time interval between onset of symptoms and appendectomy (odds ratio 41.65, 95 percent CI {confidence interval} 2.90-597.49, p<0.0001) at the public hospital. There was no independent risk factor associated with complicated appendicitis at the private hospital. CONCLUSION:There are important differences between public and private hospitals in the diagnosis and outcomes of patients with acute appendicitis submitted to appendectomy.

OBJETIVO:Comparar dados dos pacientes submetidos à apendicectomia por apendicite aguda em um hospital público e um privado. MÉTODOS: O total de 200 prontuários médicos de pacientes que foram submetidos à apendicectomia por apendicite aguda em um hospital público (n=100) e em um hospital privado (n=100) foi revisado retrospectivamente. RESULTADOS: A idade média e a distribuição dos pacientes por sexo foram similares entre os dois hospitais. Um número maior de pacientes foi previamente avaliado por outro médico no grupo operado no hospital público (n=85) do que no hospital privado (n=13) (p< 0,0001). Ultrassonografia foi realizada mais frequentemente no hospital público (n=56) do que no hospital privado (n=30) (p=0,0002). O tempo de internação hospitalar foi mais longo no hospital público (3,5±2,8 dias) do que no hospital privado (2,5±1,7 dias) (p=0,0024). Complicações pós-operatórias foram mais comuns no hospital público (n=36) do que no hospital privado (n=20) (p<0,0117). O tempo de retorno as atividades de rotina foi mais longo no hospital público (33.2±8.3 dias) do que no hospital privado (16.4±5.2 dias) (p<0,0001). A análise de regressão logística mostrou que a probabilidade estimada da apendicite complicada aumenta com o intervalo de tempo entre o início dos sintomas e a apendicectomia (p<0.001). O fator de risco independente associado com apendicite complicada foi o intervalo de tempo entre o início dos sintomas e a apendicectomia (odds ratio 41.65, 95 por cento CI 2.90-597.49, p<0.0001) no hospital público. Não houve fatores de risco independente associados com apendicite complicada no hospital privado. CONCLUSÃO: Existem importantes diferenças no processo diagnóstico e nos resultados dos pacientes submetidos à apendicectomia por apendicite aguda entre hospital público e privado.