Laparoscopic cholecystectomy and inguinal hernia repair in a patient on continuous ambulatory peritoneal dialysis

Algimantas Stašinskas, Raimundas LunevičiusVilniaus universiteto Bendrosios ir kraujagyslių chirurgijos klinika,Vilniaus greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29, LT–2043 VilniusEl paštas: [email protected], [email protected] Tikslinga priekinės pilvo sienos laukus žymėti pagal vieną sistemą ir ta sistema remtis atliekant laparoskopines operacijas. Centrinis priekinės pilvo sienos atskaitos taškas yra bamba (žymuo "O"). Priekinė pilvo siena skirstoma į keturis tradicinius kvadrantus A, B, C, D, o kiekvienas – į tris sektorius a, b, c ir tris zonas P, M, L. Dalijant į sektorius reikia pasinaudoti laikrodžio rodyklės sukimosi taisykle. Remiantis šia schema sutartiniais ženklais pažymimi 36 priekinės pilvo sienos taškai ir 36 laukai. Pateiktos keturios laparoskopinių operacijų – cholecistektomijos, apendektomijos, kirkšninės hernioplastikos ir duodenorafijos – kartogramos. Prasminiai žodžiai: pilvo sienos kartografija, pilvo sienos schema, laparoskopinė chirurgija Abdominal wall cartography and its significance in laparoscopic surgery Algimantas Stašinskas, Raimundas Lunevičius It is reasonable that the fields of the anterior abdominal wall should be marked according to one system which could be strictly preserved in laparoscopic surgery. A cartographic scheme of the anterior abdominal wall is presented in this paper. The umbilicus is the central point (mark "O"). The anterior abdominal wall was divided into four traditional quadrants, A, B, C, and D. Each of them was subdivided into 3 sectors, a, b, and c, as well as three zones P (proximal), M (middle), and L (lateral). The bourders of the sectors have to be subdivided according to a clockwise rule. Following this scheme, 36 points and 36 fields are marked. There are presented four cartographic maps for laparoscopic cholecystectomy, appendectomy, inguinal hernia repair and duodenorrhaphy. Keywords: abdominal wall cartography, abdominal map, laparoscopic surgery

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Opioid use after outpatient elective general surgery: quantifying the burden of persistent use

British Journal of Pain ◽

10.1177/20494637211032907 ◽

2021 ◽

pp. 204946372110329

Author(s):

Collin Clarke ◽

Andrew McClure ◽

Laura Allen ◽

Luke Hartford ◽

Julie Ann Van Koughnett ◽

...

Keyword(s):

Risk Factors ◽

Laparoscopic Cholecystectomy ◽

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Prescribing Patterns ◽

Income Quintile ◽

Opioid Use ◽

Opioid Prescription ◽

Open Inguinal Hernia Repair

Purpose: Surgery is a major risk factor for chronic opioid use among patients who had not recently been prescribed opioids. This study identifies the rate of, and risk factors for, persistent opioid use following laparoscopic cholecystectomy and open inguinal hernia repair in patients not recently prescribed opioids. Methods: This retrospective population-based cohort study included all patients who had not been prescribed opioids in the 6 months prior to undergoing open inguinal hernia repair or laparoscopic cholecystectomy from January 2013 to July 2016 in Ontario. Opioid prescription was identified from the provincial Narcotics Monitoring System and data were obtained from the Institute for Clinical Evaluative Sciences. The primary outcome was persistent opioid use after surgery (3, 6, 9 and 12 months). Associated risk factors and prescribing patterns were also examined. Results: Among the 90,326 patients in the study cohort, 80% filled an opioid prescription after surgery, with 11%, 9%, 5% and 1% filling a prescription at 3, 6, 9 and 12 months, respectively. Significant variability was identified in the type of opioid prescribed (41% codeine, 31% oxycodone, 18% tramadol) and in regional prescribing patterns (mean prescription/region range, 135–225 oral morphine equivalents). Predictors of continued opioid use included age, female gender, lower income quintile and being operated on by less experienced surgeons. Conclusion: Most patients who undergo elective cholecystectomy and hernia repair will fill a prescription for an opioid after surgery, and many will continue to fill opioid prescriptions for considerably longer than clinically anticipated. There is important variability in opioid type, regional prescribing patterns and risk factors that identify strategic targets to reduce the opioid burden in this patient population.

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