scholarly journals Management of perforated peptic ulcer in a district general hospital

2011 ◽  
Vol 93 (8) ◽  
pp. 615-619 ◽  
Author(s):  
AC Critchley ◽  
AW Phillips ◽  
SM Bawa ◽  
PV Gallagher
Keyword(s):  
Hospital Stay ◽  
General Hospital ◽  
Laparoscopic Repair ◽  
Open Repair ◽  
Elective Surgery ◽  
Operating Time ◽  
Laparoscopic Group ◽  
District General Hospital ◽  
Open Group ◽  
Peptic Ulcers

INTRODUCTION Laparoscopic surgery has become increasingly popular for elective surgery but it has gained slow transference to emergency surgery. The management of perforated peptic ulcers (PPU) laparoscopically is an accepted strategy yet it still remains infrequently used. The purpose of this study was to analyse the utility and outcomes of laparoscopy versus open repair for PPU in a district general hospital. In addition, we evaluated whether the subspecialty of the on-call consultant affected the method of repair performed and the training opportunities for trainee surgeons. METHODS Between 2003 and 2009, 53 patients underwent laparoscopic repair, 89 patients underwent open repair and a further 20 patients had laparoscopic repair that was converted to open repair for PPU. The results from a prospectively compiled database were analysed with primary outcome measures including operative time, length of hospital stay and mortality. RESULTS The median operating time in the laparoscopic group was 60.0 minutes compared with 50.5 minutes in the open group. Hospital stay in surviving patients was significantly shorter in patients treated completely laparoscopically (5 days) when compared with the open group (6 days) (p<0.01). There were six deaths in the laparoscopic group (11%) compared with 13 in the open group (15%) and one in the converted group (5%). Trainees performed 53% (47/89) of open repairs and 13% (7/54) of laparoscopic repairs. CONCLUSIONS Both laparoscopic and open repair are equally safe in the management of PPU. Our findings support the view that this procedure can be successfully used as a training operation.

scholarly journals Laparoscopic repair of perforated peptic ulcers without omental patch versus conventional open surgery

2018 ◽  
Vol 5 (3) ◽  
pp. 927
Author(s):  
Vaibhav Srivastava ◽  
Gyanendra Singh ◽  
Santosh K. Singh
Keyword(s):  
Laparoscopic Surgery ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Open Surgery ◽  
Open Repair ◽  
Laparoscopic Group ◽  
Peptic Ulcers ◽  
Omental Patch ◽  
Operative Complications ◽  
Repair Group

Background: Perforation of peptic ulcer usually presents as an acute abdomen. Nearly one third of the patients have no history of the disease. Laparoscopic surgery, a minimally invasive technique, has recently begun to be used on perforated peptic ulcers effectively and frequently. This study aimed to evaluate the efficacy, safety and outcome of laparoscopic surgery without omental patch for perforated ulcers in comparison with conventional open surgery.Methods: All patients diagnosed clinically with perforated peptic ulcers presenting within 24 hours of symptoms and undergoing surgery under a single surgeon during 1-year interval were included in this study and randomly assigned to laparoscopic and open repair group. Patients who had to be converted from laparoscopic surgery to open surgery, were excluded.Results: A total of 69 patients were included in this study. Number of doses of analgesics required in laparoscopic group was 9.48 ± 1.82, while those required in conventional open group was 18.16±2.24. In laparoscopic duodenal perforation repair group, duration of hospital stay (in days) was 8.42±1.44 as compared to 12.08±4.82 in open repair group. Laparoscopic group had significantly fewer post-operative complications but had longer mean operative time (101.90 minutes compared to 60.32 minutes in open repair group).Conclusions: Laparoscopic closure of perforated duodenal ulcer is a simple and safe procedure in experienced hands. It maintains the benefits of the minimally invasive approach. It is associated with longer operating time, less postoperative pain, less post-operative complications, a shorter postoperative hospital stay, and earlier returns to normal daily activities.

scholarly journals Comparison between Laparoscopic and Open Repair of Umbilical and Paraumbilical Hernia: A Randomized Controlled Trial Study

2021 ◽  
pp. 127-135
Author(s):  
Arti Mitra ◽  
Unmed Chandak ◽  
Shiv Kumar Sahu ◽  
Yuvraj Pawaskar ◽  
Akanksha Waldia
Keyword(s):  
Laparoscopic Repair ◽  
Open Repair ◽  
Tertiary Care ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Open Group ◽  
Paraumbilical Hernia ◽  
Early Return ◽  
Open Mesh Repair ◽  
The Mean

Background: Laparoscopic repair of umbilical and paraumbilical hernia has largely replaced conventional (Open) repair. The purpose of the study was to compare the effectiveness of laparoscopic vs. open repair of umbilical & para umbilical hernia in a tertiary care government hospital. Methods: A total 50 patients of age >18 years diagnosed with umbilical and paraumbilical hernia who underwent laparoscopic and open hernia repair from May2018 to Nov 2020 were enrolled and divided into two groups of 25 patients in each. The patients were followed up in the post-operative period in the wards during daily rounds till the time of discharge; 1 and 6 months after discharge and yearly. Results: The mean age for open group was 44.24±7.68years while the mean age for laparoscopic group was 50.0±11.82years. Operative time was more in laparoscopic repair (81.68±18.37min) as compared to open (55.44±16.54min). Post-operative pain (VAS score) was greatest in the open group in comparison to lap group at 6 hr, 24 hr, day 8 and at 1month. Postoperative overall complication rate (Infection, seroma and recurrence) was 12% in the laparoscopic group and 28% in the open group. Recovery was faster with laparoscopic repair with a mean postoperative hospital stay of 3.28days as compared to 5.88days for open mesh repair. Patients treated with laparoscopic repair were early return to routine activity and work. Conclusion: The laparoscopic approach appears to be safe, effective and acceptable. It is a complex but very efficient method in experienced hands and it offered a significant advantage over open repair.

scholarly journals A Comparative Study Between Laparoscopic Versus Open Incisional Hernia Repair

2016 ◽  
pp. 29-33
Author(s):  
Md Noor A Alam ◽  
Md Rajibul Haque Talukder ◽  
Md Roushan Iqbal ◽  
Raihan Anwar ◽  
Humayun Kabir Chowdhury
Keyword(s):  
Incisional Hernia ◽  
Hospital Stay ◽  
Laparoscopic Repair ◽  
Open Repair ◽  
Laparoscopic Group ◽  
Incisional Hernia Repair ◽  
Synthetic Mesh ◽  
Open Procedure ◽  
Significant Difference ◽  
One Year

Aims: This study aims to compare between laparoscopic and open incisional hernia repair.Methods and Materials: The study was conducted in different tertiary hospitals of Dhaka between January 2011 to December 2012 and in 96 patients with incisional hernia. Among them, 68 patients underwent open repair and 28 underwent laparoscopic repair. Both procedures usually consisted of applying a synthetic mesh overlapping the defect. They were followed up for one year to observe the clinical outcome.Results: Mean operative time was shorter in laparoscopic group in comparison to open procedure and mean post operative hospital stay was less than 3 days in laparoscopic group and above 7 days in open group. In the laparoscopic group return to normal activities/work after surgery was less than 2 weeks but after open procedure it was more than 3 weeks. Analgesics requirement was also lower in the laparoscopic group. Post operative complications were observed in 33.82% (23) patients in open hernioplasty group and in 7.14% (2) patients in laparoscopic group which showed significant difference (p<0.05). There was no recurrence in the laparoscopic group during one year follow-up.Conclusion: Data suggest laparoscopic repair is superior to open repair because of less complications, relapses and short hospital stay but long term follow up is required.Birdem Med J 2015; 5(1) Supplement: 29-33

scholarly journals Laparoscopic Repair of Inguinal Hernia : Early Experience in A Tertiary Care Hospital

2016 ◽  
Vol 4 (1) ◽  
pp. 19-22
Author(s):  
Sharmistha Roy ◽  
Samiron Kumar Mondal ◽  
Tapas Kumar Maitra
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Laparoscopic Repair ◽  
Open Repair ◽  
Laparoscopic Group ◽  
Normal Activity ◽  
Laparoscopic Inguinal Hernia Repair ◽  
Open Group ◽  
Laparoscopic Inguinal Hernia

Background : The introduction of laparoscopic techniques has added a new dimension to groin hernia surgery. The laparoscopic repair of inguinal hernia has had a staggering beginning in the surgical arena. Laparoscopic repairs have had to compete with the current gold standard for inguinal hernia repair ie Liechtenstein repair. This study shows the results of laparoscopic inguinal hernia repair in comparison to open repair in a similar group of patients.Methods and materials : This is a prospective study done on 50 male patient of inguinal hernia aging from 18- 65years. Among 50 patients selected for study 25 patient underwent open hernioplasty and 25 patient underwent laparoscopic hernioplasty. In the laparoscopic group, in 20 patients (80%) TAPP procedure was done & in 5 patients (20%) TEP procedure was done.Aims and Objective : The aim of this study is to compare the effectiveness and safety of laparoscopic and conventional open repair, in the treatment of inguinal hernia.Results : Average operating time in open procedure was 55±12 minutes, and in laparoscopic procedure 65±10 minutes. Opoid analgesics were required in 36% patient in open group and 16% in laparoscopy group. Within 7 days most of the patient (76%) in laparoscopic group returned to their normal activity, but in the open group 92% patient required more than 7 days to return to normal activity. Post operative complication like hematoma formation (8%), Testicular pain (8%), retention of urine (3%), and mesh infection (4%) was more in open repair than in laparoscopic repair. In Laparoscopic group 1patient (5%) had bladder injury, and 1 patient (5%) developed illeus.Conclusion : Early results of laparoscopic inguinal hernia repair are encouraging, but the chance of organ injury like bladder, or major vessel injury are more. So laparoscopic repair of inguinal hernia should only be practiced with adequate training and experience in laparoscopic surgery.Bangladesh Crit Care J March 2016; 4 (1): 19-22

Troponin T: role in altering patient management and enabling earlier discharge from a district general hospital

2001 ◽  
Vol 38 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Avril Owen ◽  
Waqas Khan ◽  
Keith D Griffiths
Keyword(s):  
Hospital Stay ◽  
General Hospital ◽  
Patient Management ◽  
Troponin T ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Patient Discharge ◽  
District General Hospital ◽  
Early Discharge ◽  
Control Group

The use of troponin T to facilitate early patient discharge was investigated in a prospective study in a district general hospital. Troponin T was measured in 91 patients admitted over a period of 6 months with chest pain but without evidence of myocardial infarction. The main outcome measure was length of hospital stay. A negative troponin T was found in 70 patients. Fifty of these were discharged within 24h of the troponin result being available and they had a significantly shorter hospital stay than a case-control group and a historical control group from the previous 6 months. Troponin T measurement has a role in altering patient management by enabling early discharge, resulting in significant cost savings and increasing bed availability.

scholarly journals Introducing a reserve waiting list initiative for elective general surgery at a District General Hospital

2019 ◽  
Vol 8 (3) ◽  
pp. e000745 ◽  
Author(s):  
Vaki Antoniou ◽  
Olivia Burke ◽  
Roland Fernandes
Keyword(s):  
General Hospital ◽  
General Surgery ◽  
Fast Track ◽  
Operating Time ◽  
District General Hospital ◽  
Waiting List ◽  
Related Factors ◽  
Simple Protocol ◽  
Significant Burden ◽  
Training Opportunities

Cancelled operations represent a significant burden on the National Health Service in terms of theatre efficiency, financial implications and lost training opportunities. Moreover, they carry considerable physical and psychological effects to patients and their relatives. Evidence has shown that up to 93% of cancelled operations are due to patient-related factors. An analysis at our District General Hospital revealed that approximately 18 operations are cancelled on the day of surgery each month. This equates to 27 hours of allocated operating time valued by the trust as £67 500, not being used effectively. This retrospective quality improvement report aims to reduce unused theatre time due to cancelled elective operations in general surgery theatres—thereby improving theatre efficiency and patient care. To ascertain the baseline number of cancelled operations, an initial review of theatre cases was undertaken. Further review was then completed after implementation of two improvements—a short notice surgical waiting list and fast track pre-assessment clinics. The results showed that implementation of the reserve surgical waiting list reduced unused operating time by an average of 2.25 hours per month. By further adding in the fast track preassessment clinic, these figures increased to an average of 11.5 hours over the next 3 months. This precipitated a reutilisation of otherwise wasted theatre time. Economic impact of this time amounts around £28 750 a month, after implementation of both improvements. Simple protocol changes can lead to large improvements in the efficient running of theatres. The resultant change has improved patient satisfaction, led to greater training opportunities and improved theatre efficiency. Extrapolation of our results show better usage of previously underused theatre time, to the equivalent worth of £345 000. Further implementation of these improvements in other surgical specialities and hospitals would be beneficial.

Cancellation of elective surgery – any improvement after ten years?

2006 ◽  
Vol 88 (1) ◽  
pp. 28-30 ◽  
Author(s):  
XL Griffin ◽  
DR Griffin ◽  
AR Berry ◽  
DC Hunter
Keyword(s):  
Resource Management ◽  
General Hospital ◽  
Elective Surgery ◽  
District General Hospital ◽  
Waiting List ◽  
Admission Process

Cancellation of elective operations represents a waste of resources and a poor standard of service to patients who may already have spent several months on a waiting list. The purpose of this study was to determine the extent of the problem in a typical district general hospital, how it has changed over a period of ten years and whether alterations in resource management in the admission process have led to improvements in service.

scholarly journals EP.TU.44Improving Access to Surgery: The F1 ‘Theatre Day’ Programme

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rebecca Nunn ◽  
Santhini Jeyarajah
Keyword(s):  
General Hospital ◽  
General Surgery ◽  
Elective Surgery ◽  
Working Hours ◽  
District General Hospital ◽  
Learning Opportunities ◽  
Learning Opportunity ◽  
Access To Surgery ◽  
Common Barriers

Abstract Aims To identify barriers in theatre attendance, facilitate access and maximise learning opportunities for surgical F1s (Foundation Year 1 Doctors) at a DGH (District General Hospital). Methods Between December 2019- December 2020, each F1 doctor was offered a day to spend in elective theatre during their General Surgery rotation (excluding emergency COVID rota periods). This was following feedback from the August- December 2019 cohort. Each ‘Theatre Day’ was scheduled during normal working hours when there was sufficient staff. Post-participation questionnaires were completed. Results Prior to implementation of the Programme, 3/8 F1s surveyed had not attended any elective surgery lists (1 had not attended theatre at all). All indicated that they would have been interested in attending a timetabled elective theatre day; 88% highlighted a ‘lack of staff’ and 63% indicated that ‘feeling guilty’ were barriers in attending theatre. 21 F1s were offered a ‘Theatre Day’: 17 agreed to participate and 16 completed post-participation questionnaires. Only 47% confirmed that they were considering a career in surgery prior to participation: all agreed that spending time in theatre was a useful learning opportunity and 94% agreed that the Programme should be continued. Conclusions Spending time in theatre appears to be valued as a useful learning opportunity for F1s, whether or not they are aspiring surgeons. Common barriers to self-organised theatre attendance appear to be an anticipated ‘lack of staff’ or feelings of ‘guilt’. A senior-led scheduling of one day in theatre should circumnavigate these barriers and ensure that access is available to all.

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