EP.TH.447Simultaneous repair of bilateral Inguinal hernia under Local Anaesthetic - is it feasible?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
T Athisayaraj ◽  
J Olugbemi ◽  
B Sebastian ◽  
E Coveney
Keyword(s):  
Patient Satisfaction ◽  
Inguinal Hernia ◽  
Pain Score ◽  
Local Anaesthetic ◽  
Operating Time ◽  
Bilateral Inguinal Hernia ◽  
Inguinal Hernias ◽  
High Satisfaction ◽  
Patient Reported ◽  
High Satisfaction Rate

Abstract Introduction Local Anaesthetic repair of unilateral Inguinal hernia is well reported in the literature, as a safe, well tolerated and effective operation. However, there is not much literature on simultaneous repair of bilateral inguinal hernias under local anaesthetic. We are reporting our experience with simultaneous repair of bilateral inguinal hernias under local anaesthetic. Methods We did a retrospective analysis of prospectively collected data of patients, who had bilateral inguinal hernia repaired under local anaesthetic over a period of 2009 - 2019, looking at the patient demographics, patient reported pain score, operating time, volume of local anaesthetic used, patient satisfaction and complication rates.All the patients had Lichtenstein's hernioplasty. The LA mixture was made up of 30ml 0.5% Bupivacaine with adrenaline, 20 ml 2% Lignocaine with adrenaline, 50 ml of 0.9% Saline and 6 ml of 8.6% Sodium Bicarbonate. All these surgeries were performed on a day case basis. Results There were 24 patients, who underwent local anaesthetic repair of bilateral inguinal hernias, 22 Males and 2 Females. Age range was 35 - 81 years. The BMI varied from 18 - 30, with a mean of 24. The average operating time was 66.8 minutes (38 - 120 minutes, median 60 min). The mean pain score was 24, on a 0-100 scale. Patient satisfaction scores varied from 50-100 (Median 90, Mean 88.1) Conclusion We conclude that successful simultaneous repair of bilateral inguinal hernia under local anaesthetic is feasible, with a low level of patient discomfort, high satisfaction rate and using safe quantities of local anaesthetic

scholarly journals Laparoscopic Versus Conventional Open Surgery for the Treatment of Bilateral Inguinal Hernias

2018 ◽  
Vol 3 (3) ◽  
pp. 181-185
Author(s):  
Előd Etele Élthes ◽  
Alexandra Lavinia Cozlea ◽  
Márton Dénes ◽  
Cristian Borz ◽  
Kálmán Sárdi ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Return To Work ◽  
Open Surgery ◽  
Operating Time ◽  
Synthetic Mesh ◽  
Bilateral Inguinal Hernia ◽  
Open Procedure ◽  
Inguinal Hernias ◽  
Hospitalization Period ◽  
Conventional Open Surgery

Abstract Objective: To evaluate and compare laparoscopic and conventional open procedures for bilateral inguinal hernia surgical repair, using clinical, intraoperative, and postoperative criteria. Methods: Forty-three patients with bilateral inguinal hernia were included in a retrospective study, between 2014–2017. All patients underwent conventional open or laparoscopic bilateral hernioplasty, and were divided into two groups: a conventional open group (COG) and a laparoscopy group (LG). Clinical, intraoperative, and postoperative outcomes were reviewed. Results: In the laparoscopic hernioplasty group, there was a significantly shorter hospitalization period (p = 0.026), less postoperative pain (p = 0.03), and a prompt return to work (p = 0.043) compared to the conventional open procedure. On the other hand, patients who underwent hernioplasty with the Progrip-type synthetic mesh developed a lower pain score, an earlier return to work, and a quick start to normal physical activities in comparison with other mesh types used for the treatment of bilateral inguinal hernias. For patients who underwent conventional open procedure, there was a significantly shorter operating time (p = 0.042). Conclusion: Laparoscopic bilateral inguinal hernioplasty is a time-consuming and technically demanding procedure. However, the current study underlines the benefits of this type of surgery. This technique presents comparable clinical, intraoperative, and postoperative results with the conventional open surgery.

scholarly journals A 9-year experience study of single-port micro-laparoscopic repair of pediatric inguinal hernia using a simple needle

Hernia ◽  
2019 ◽  
Vol 24 (3) ◽  
pp. 639-644
Author(s):  
R. Chen ◽  
S. Tang ◽  
Q. Lu ◽  
X. Zhang ◽  
W. Zhang ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Single Port ◽  
Average Length ◽  
Operating Time ◽  
Laparoscopic Approach ◽  
Invasive Procedure ◽  
High Ligation ◽  
Laparoscopic Technique ◽  
Inguinal Hernias ◽  
Laparoscopic Techniques

Abstract Purpose As laparoscopic techniques and equipments improve, laparoscopic inguinal hernia repair has been gaining popularity. The objective of the study was to summarize 9 years of experience using a single-port micro-laparoscopic approach to repair pediatric inguinal hernias with a simple hernia needle. Methods 1880 children with inguinal hernias were enrolled using micro-laparoscopic surgery between June 2009 and 2018. All patients underwent high ligation surgery using a single-port micro-laparoscopic technique. The clinical data were retrospectively analyzed. Results All micro-laparoscopic surgeries were successfully performed in the 1880 patients, who ranged in age from 2 months to 14 years (3.66 ± 2.96 years) including 1622 males and 258 females. Among them, 1299 cases were unilateral hernias and 581 cases were bilateral hernias. The average operating time was 12.5 ± 3.5 min for a unilateral hernia and 20.5 ± 4.5 min for bilateral hernias. All patients were discharged 1–2 days after surgery, and the average length of their hospital stay was 2–4 days. Complications of knot reaction and pneumoscrotum occurred in 5 cases (0.27%) and 54 cases (2.87%), respectively, but these cases were properly managed, with no major impact on the operational outcomes. All patients were followed up for 3–65 months; there were 13 recurrent cases (0.69%). Conclusions Single-port micro-laparoscopic herniorrhaphy in children using a simple hernia needle is a reliable and minimally invasive procedure.

Abstract TMP74: Telepresence and Provider Communication Predict Satisfaction With Telestroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Griffin T Selch ◽  
Michael J Lyerly ◽  
Holly Martin ◽  
Glenn Graham ◽  
Sharyl Martini ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Patient Experience ◽  
Stroke Severity ◽  
Provider Communication ◽  
Veterans Health ◽  
Health Administration ◽  
Chi Square ◽  
High Satisfaction ◽  
Patient Reported ◽  
Student’S T

Background: In 2016 the Veterans Health Administration implemented the first nationwide Telestroke program; 800 consults were completed in the first 18 months. Preliminary analysis showed Veterans reported high satisfaction and acceptance of the program. This study sought to understand patient, provider, and hospital-level factors associated with patient satisfaction. Methods: Patients who received a Telestroke consultation were eligible for a phone interview two weeks later, including standard questions about technology quality, telepresence (how much the encounter felt like face-to-face), Telestroke provider communication, and overall satisfaction. Satisfaction scores ranged from 1-7, (higher = more satisfied), and for analyses were dichotomized as 6-7 indicating high satisfaction vs. < 6. Patient variables including stroke severity (NIH Stroke Scale) were obtained from study records. We used Student’s t-tests and Chi-square tests to compare variables related to patient-reported satisfaction, and used a logistic regression model to determine factors independently associated with high satisfaction. Results: Over 18 months, 208 interviews were completed and 156 (75%) reported high satisfaction with Telestroke. Patients with more severe stroke were less likely to recall the consultation (p = 0.01). Factors significantly associated with patient satisfaction were higher ratings of the technology (p < 0.0001), telepresence (p < 0.0001), provider communication ratings (p < 0.0001) and overall VA satisfaction (p = 0.01). Among 13 providers with at least 10 consultations, there was no difference in mean patient satisfaction scores. In the multivariate model, telepresence (OR 3.10, 95% CI 1.81-5.31) and provider communication scores (OR 2.37, 95% CI 1.20-4.68) were independently associated with satisfaction. Conclusion and Potential Impact: Provider qualities, including telepresence and provider ratings, were associated with overall Veteran satisfaction with Telestroke. Technology quality may be necessary but not sufficient to impact patient experience. Training providers to improve telepresence and communication skills could improve patient experience with Telestroke consultation.

scholarly journals Non-Surgical Correction of Nasal Dorsum and Tip in Primary Cases

2019 ◽  
Vol 46 (2) ◽  
pp. 47-50
Author(s):  
Y. P. Yordanov ◽  
A. Shef
Keyword(s):  
Patient Reported Outcomes ◽  
Major Complication ◽  
Aesthetic Medicine ◽  
Non Invasive ◽  
High Satisfaction ◽  
Retrospective Clinical Study ◽  
Patient Reported ◽  
High Satisfaction Rate ◽  
Preliminary Study ◽  
Non Surgical Treatment

Abstract Nowadays, minimally invasive and non-invasive approaches in aesthetic medicine are increasingly popular and non-surgical rhinoplasty is one of the procedures with rising demand worldwide. In Bulgaria, this procedure seems to be uncommonly performed, since there are no reports in the local scientific literature. The aim of this preliminary study was to briefly explore the possibilities of hyaluronic acid (HA) fillers for correcting three of the most common nasal deformities – dorsal hump, under-projected and under-rotated nasal tip in primary cases. In order to accomplish this objective, a retrospective clinical study was conducted encompassing 11 cases of the authors’ practices with the above mentioned nasal irregularities and no previous surgical/non-surgical treatment. The analysis of patient-reported outcomes suggested a high satisfaction rate, with no major complication in the series. The HA filler has shown to be safe, relatively easily applicable and highly effective for camouflaging nasal deformities. A special emphasis was put on the patient safety and ten golden rules for staying out of trouble were given.

scholarly journals 1598 Local Anaesthetic or General Anaesthetic: The Optimal Choice for Inguinal Hernia Repair

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Mushonga
Keyword(s):  
Inguinal Hernia ◽  
Local Anaesthetic ◽  
Inguinal Canal ◽  
Operating Time ◽  
Optimal Choice ◽  
General Anaesthetic ◽  
Significant Difference ◽  
Surgeon Experience ◽  
Randomised Control Trials ◽  
Post Operative Nausea

Abstract Aim Inguinal hernias occur when visceral tissue protrudes through the inguinal canal [1]. Around 20 million inguinal hernia repairs (IHR) are done annually worldwide and involve re-enforcement of the compromised wall of the inguinal canal using polypropylene mesh via open anterior approach or minimally invasive laparoscopy [2,3]. Despite gold standards in surgical approach, there’s no distinctively superior practice between local anaesthetic (LA) and general anaesthetic (GA). Therefore, the objective was to review IHR under both LA and GA and investigate which method is conductive to optimal patient outcomes. Method Systematically reviewed randomised control trials (RCTs) evaluating the benefits of LA over GA in IHR, by comparing factors such as post-operative nausea, urinary retention (UR), haematoma, wound infection (WI), pain, and operating time. PubMed was utilised for finding suitable studies, and data was obtained and summarised appropriately. Results Data assembled from RCTs evaluating benefits of LA over GA in IHR indicated no significant difference between groups when comparing nausea, UR, haematoma, WI and pain [4]. Supporting studies reviewing RCTs juxtaposing GA and LA in IHR elucidated no significant variance in operating time, haematoma and WI [5]. Patients did show less rates of UR, reduced pain scores and greater patient satisfaction under LA [5]. Conclusions LA is used in specialised hernia clinics due to less cardiovascular risk however development of short-acting GA’s allows for suitability for day-case surgery. Future investigation is required taking into account factors like surgeon experience, patient anatomy and economic viability for a definitive gold standard.

Low Negative Pressure Combined With Supertumescence Microliposuction As a New Method For Repairing Facial Fat Overfilling: A Case Series of 32 Patients

2021 ◽  
Author(s):  
Bo Yin ◽  
Xinyu Zhang ◽  
Lei Cai ◽  
Xuefeng Han ◽  
Facheng Li
Keyword(s):  
Patient Satisfaction ◽  
Negative Pressure ◽  
Case Series ◽  
Muscle Paralysis ◽  
Standard Score ◽  
High Patient Satisfaction ◽  
Satisfaction Rate ◽  
High Satisfaction ◽  
The Face ◽  
High Satisfaction Rate

Abstract Background Face fat overfilling sometimes occurs and is very difficult to repair unfortunately. Objectives The authors report their first experience of micro-liposuction with low negative pressure combined with super-tumescence (LNPST) in a case series of 32 patients. Methods The LNPST micro liposuction was performed in 32 patients aged 22 to 41 (mean, 29.6±4.9) years with facial overfilling. Two independent plastic surgeons intraoperatively monitored and recorded discomfort and bleeding using a grading system. All patients were followed up for haematoma within 1 week postoperatively and for skin numbness and muscle paralysis at 1 week and 3 months postoperatively. In addition, 6 months postoperatively, patient satisfaction with the postoperative aesthetic effects was analysed by Face-Q. Results All patients successfully completed the operation under local anaesthesia. The intraoperative discomfort and blood-loss scores were 1.69±0.62 and 1.22±0.41, respectively. The haematoma score was 1.13±0.34 within 1 W [other scores: postoperative skin numbness (1 W: 1.96±0.62; 3 M: 1.13±0.33) and postoperative muscle paralysis (1 W: 1.22±0.51; 3 M: 1.0±0)]. Overall, neither skin necrosis nor serious complications requiring revision surgery occurred. Seventy-two percent of the patients (n = 23) answered the Face-Q questionnaire (21.8±1.7), covering satisfaction with the outcome score into a standard score (81.7±15.1, from 0 to 100), which verified the high satisfaction rate. Conclusions LNPST technology is a safe and effective method for facial-fat-overfilling repair, with less bleeding, less neuro injury, fewer complications and high patient satisfaction.

scholarly journals Validation of a one-stop carpal tunnel clinic including nerve conduction studies and hand therapy

2011 ◽  
Vol 93 (8) ◽  
pp. 634-638 ◽  
Author(s):  
C Ball ◽  
M Pearse ◽  
D Kennedy ◽  
A Hall ◽  
J Nanchahal
Keyword(s):  
Patient Satisfaction ◽  
Carpal Tunnel Syndrome ◽  
Grip Strength ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Operating Time ◽  
Nerve Conduction Studies ◽  
Patient Reported ◽  
One Stop ◽  
Tunnel Syndrome

INTRODUCTION Carpal tunnel syndrome is the most common hand disorder. We describe a pathway that includes clinical assessment, neurophysiological testing, surgery and physical therapy all at the same visit. METHODS All referrals for carpal tunnel syndrome were screened for inclusion in a ‘one-stop’ surgeon-led clinic. Prospective clinical data collected included patient reported outcome measures and satisfaction scores, touch threshold, pinch and grip strength. Patients were assessed clinically, underwent nerve conduction studies and surgery as indicated, all on the same day. Baseline and one-year follow-up data were analysed for 57 patients (62 hands). RESULTS There was significant improvement in all domains of the Boston Carpal Tunnel and Michigan Hand Outcomes questionnaires, grip strength and touch threshold. There were no adverse events. The total mean operating time was 12.8 minutes (range: 5–15 minutes) and the mean tourniquet time was 2.5 minutes (range: 1–11 minutes). Using a dual theatre model produced a short mean turnaround time of 14.8 minutes (range: 2–37 minutes). Patient satisfaction as judged using a Picker questionnaire was very high. CONCLUSIONS A highly efficient clinical service involving both diagnostics and treatment can be delivered at a single hospital visit while maintaining optimal outcomes and high patient satisfaction.

PATIENT SATISFACTION AND DISABILITY AFTER BRACHIAL PLEXUS SURGERY

Neurosurgery ◽  
2009 ◽  
Vol 65 (suppl_4) ◽  
pp. A189-A196 ◽  
Author(s):  
Thomas Kretschmer ◽  
Sarah Ihle ◽  
Gregor Antoniadis ◽  
Julia A. Seidel ◽  
Christian Heinen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Return To Work ◽  
Brachial Plexus ◽  
Dash Score ◽  
Measurement Instruments ◽  
High Satisfaction ◽  
High Satisfaction Rate ◽  
Specific Outcome ◽  
The Mean ◽  
Brachial Plexus Surgery

Abstract OBJECTIVE Little is known about patient satisfaction and disability after brachial plexus surgery. Would patients undergo the procedure again, if they knew the current result beforehand? How do they rate their result and their disability? METHODS Of 319 plexus patients who had undergone surgery between 1995 and 2005, 199 received a 65-item questionnaire. Measurement instruments included a new plexus-specific outcome questionnaire (Ulm Questionnaire) with categories of satisfaction, functionality, pain, comorbidities, and work; and the disability of the arm, shoulder, and hand questionnaire (DASH; scale, 0–100). RESULTS Of 99 returned questionnaires, 70 were returned in a useful form for evaluation. The results of patients with C5–C6 lesions (21 of 70) are as follows: 90% (19 of 21) would undergo surgery again, 95% (20 of 21) were satisfied with the result, and 86% (18 of 21) subjectively improved. The mean DASH score was 41 (standard deviation [SD], 24). The results of patients with C5–C7 lesions (6 of 70) are as follows: 50% (3 of 6) were satisfied and would undergo surgery again, and 67% (4 of 6) improved. The mean DASH score was 46 (SD, 13). The results of patients with C5–T1 lesions (43 of 70) are as follows: 67% (29 of 43) would undergo surgery again, 81% (35 of 42) were satisfied, and 74% (32 of 43) reported improvement. The mean DASH score was 58 (SD, 26). The overall mean DASH score was 52 (SD, 26). Pain since the injury was prevalent in 86% of patients (60 of 70), back pain in 53%, and depression/anxiety in 21%. Fifty-two percent of those who worked before their injury (27 of 53 patients) remained unemployed or incapacitated for work. Forty-five percent of previous workers (24 of 53) returned to their former occupation. Occupational retraining was successful for 70% of patients (16 of 23). The mean duration until return to work was 9 months overall and 5 months for those who returned to their previous occupation. CONCLUSION Eighty-seven percent of patients were satisfied with the results and 83% would undergo the procedure again. Despite a high satisfaction rate, patients remained considerably disabled, and half of the previous workers did not return to work. Occupational retraining is effective.

scholarly journals Local anaesthetic repair of paraumbilical hernia as a safe option across a range of body mass indices

2020 ◽  
Vol 102 (4) ◽  
pp. 290-293
Author(s):  
ID Sadien ◽  
YM Ho ◽  
E Coveney
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Body Mass ◽  
Local Anaesthetic ◽  
High Body Mass Index ◽  
Paraumbilical Hernia ◽  
Pain Scores ◽  
Significant Difference ◽  
Patient Reported ◽  
Duration Of Operation

Introduction Local anaesthetic repair of paraumbilical hernia (PUH) is a commonly performed operation. The aim of this study was to investigate whether local anaesthesia (LA) repair of PUH was feasible in patients with a high body mass index (BMI) and whether BMI had an impact on patient reported pain scores. Methods Patients undergoing PUH repair under the care of single consultant in a district general hospital between March 2010 and January 2018 were recruited. Patient demographics, BMI, duration of operation, volume of LA infiltrated and grade of operating surgeon were available from the consultant’s database. The database also included prospectively recorded patient reported pain scores based on a numerical scale (0–100) and overall patient satisfaction measured as a percentage. Patients were divided into three BMI categories: <25kg/m2, 25–30kg/m2 and >30 kg/m2. Results A total of 123 patients underwent PUH repair under LA during the study period. Six patients had no recorded BMI and were excluded from the analysis. Of the remaining 117 patients, 36 (31%) were in the normal BMI range, 35 (30%) in the overweight range and 46 (39%) in the obese range. There was no statistically significant difference between the BMI groups in terms of volume of LA used, duration of operation, postoperative pain scores or patient satisfaction. Conclusions LA repair of PUH is feasible for patients with a raised BMI and does not result in higher postoperative pain scores or the need for higher doses of LA.

scholarly journals A comparative study of Stoppa’s repair versus Lichtenstein technique for surgical management of bilateral inguinal hernia

2021 ◽  
Vol 8 (11) ◽  
pp. 3307
Author(s):  
Kiran Patel
Keyword(s):  
Inguinal Hernia ◽  
Surgical Management ◽  
Intraoperative Complications ◽  
Bilateral Inguinal Hernia ◽  
Local Skin ◽  
Tension Free ◽  
Inguinal Hernias ◽  
Significant Difference ◽  
Group 2 ◽  
Mesh Hernioplasty

Background: The surgical management of bilateral inguinal hernias has been a point of contention for a long time, particularly in terms of whether to repair them sequentially or simultaneously, especially following tension-free surgeries. The present study was planned to compare the outcomes of bilateral inguinal hernia repair between patients who underwent the Stoppa’s repair and those who underwent Lichtenstein tension free mesh hernioplasty repair.Methods: The study included all patients of both genders with age of 18 years with bilateral inguinal hernias. Patients with following any condition-a complicated inguinal hernia; an obstructed or strangulated inguinal hernia; a recurrent inguinal hernia; previous abdominal surgery; a local skin infection-were excluded from the study. Patients were randomised into 2 groups based on simple randomization-group 1: patients underwent Lichtenstein tension free mesh hernioplasty; and group 2: patient underwent Stoppa's repair.Results: The operative time was significantly shorter in group 2 patients as compared to group A. In both groups, there were no intraoperative complications. Group 2 patients had significantly lower postoperative pain scores measured by the visual analogue scale at 12 hours postoperatively, but there was no statistically significant difference in pain at 24 hours or 7 days postoperatively. Post-operative hospital stays, return to normal daily activities, and chronic groin pain, there was no statistically significant difference between the two groups.Conclusions: The present study was unable to show that either technique was superior in the treatment of bilateral inguinal hernias. Both procedures, on the other hand, were capable of achieving favourable postoperative outcomes and had similar problems.

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