Hernioplastia inguinal ambulatoria con anestesia local y sedación: análisis de 1.840 pacientes tras 6 años de seguimiento / Inguinal hernia repair in day surgery setting: a 6 years review in 1840 patients

Introducción: Estudio para evaluar a largo plazo la aplicación y los beneficios del tratamiento de la hernia inguinal con la prótesis de prolene hernia system (PHS), con anestesia local y sedación y en programa de cirugía mayor ambulatoria. Pacientes y métodos: En el periodo 1997-2005 fueron tratados 2.138 pacientes con hernia inguinal en la unidad de cirugía mayor ambulatoria. Todos fueron anestesiados con anestesia local, una mezcla en 20 ml de suero fisiológico de 10 ml de lidocaína al 5 % y 10 ml de bupivacaína con adrenalina. Asimismo, todos fueron sedados con midazolan (0,5-2 mg) y propofol (0,5 ml/kg). Las hernioplastias se realizaron según la técnica de Gilbert y no se empleó quimiprofilaxis de forma rutinaria. El dolor postoperatorio fue valorado según una escala analógica visual. El dolor leve y moderado fue tratado con analgésicos antiinflamatorios no esteroideos o paracetamol. El tiempo medio de los pacientes para el alta en la unidad fue de 6 horas. Se realizaron controles postoperatorios a los 30 días, 3 meses y 6 años por teléfono y siempre que fuese necesario. Resultados: Del total de pacientes intervenidos, en 1.840 casos (86,1 %) se realizó un seguimiento y fueron controlados a los 6 años. Todos habían sido intervenidos en circuito sin ingreso, 147 (7,98 %) mujeres y 1.693 (92,02 %) hombres, y no presentaron eventos adversos en el periodo postoperatorio. La edad media fue de 56 (18-82 años). La clasificación de Gilbert fue I: 15 (0,81 %), II: 49 (2,66 %), III: 736 (40 %), IV: 939 (51,03 %) y V: 101 (5,48 %). En el 91,95 % eran hernias primarias y recidivadas el 8,04 %. La revisión a los 6 años mostró curación en 1.824 pacientes (99,13 %), curación con alguna secuela en 6 pacientes (0,32 %) y recidivas herniarias en 10 pacientes (0,54 %). Conclusiones: El estudio presentado demuestra a largo plazo que la técnica de PHS realizada bajo anestesia local y sedación consciente en un programa de cirugía sin ingreso es un procedimiento efectivo con muy escaso número de recidivas (AU)

Aim: The study is conducted to evaluate long time the feasibility and benefits of inguinal hernia repair with prolene hernia system (PHS) mesh using local anaesthesia with sedation as a day surgery procedure. Patients and methods: 2138 patients with inguinal hernia were attended in the day surgery setting from 1997 to 2005. Patients were sedated with midazolam (0.5-2 mg) and propofol (0.5 ml/kg). Local anaesthesia (20 ml saline solution, 10 ml lidocaine (5 %) and 10 ml bupivacaine with adrenaline. Hernioplasties were performed according to Gilbert technique. No routine chemoprophylaxis. Postoperative pain was assessed using analogical visual scale pain. Mild and moderate postoperative pain was managed with simple analgesics or NSAID or paracetamol. Patients were discharged at 6 hours. Postoperative controls: 30 days, 3 months and 6 years by phone, and always was necessary. Results: 1840 (86,1 %) were controlled 6 years. They were operated as day cases, 147 women (7,98 %) and 1693 men (92,02 %). Mean age was 56 (18-82 years). Gilbert’s classification: I-15 (0.81 %), II-49 (2.66 %), III-736 (40 %), IV-939 (51.03 %) and V-101 (5.48 %). Primary hernias were 1692 (91.95 %) and recurrent 148 (8.04 %). The review at 6 years showed healing in 1824 patients (99.13 %), cure with a sequel in 6 patients (0.32 %) and hernia recurrences in 10 patients (0.54 %). Conclusion: The study presented demonstrates the long term PHS technique performed under local anesthesia and conscious sedation in a program of outpatient surgery is an effective procedure with very low number of relapses (AU)

Dolor persistente tras hernioplastia inguinal: estudio descriptivo a largo plazo / No disponible

Introducción: Dolor crónico es aquel que permanece tras 3 meses desde la intervención quirúrgica. De etiología multifactorial, puede llegar a ser invalidante para el paciente. Objetivos: Conocer, en nuestro medio, la prevalencia del dolor crónico posthernioplastia inguinal en cirugía programada y régimen ambulatorio. Material y métodos: Estudio descriptivo retrospectivo de los pacientes diagnosticados de hernia inguinal e intervenidos de manera programada en cirugía mayor ambulatoria entre enero de 2000 y diciembre de 2006. Dolor inmediato: primeras 72 horas; dolor agudo: 3 primeros meses; dolor crónico: más de 3 meses. Seguimiento: llamada telefónica a las 24 y 48 horas del alta, revisión en consulta al mes y llamada telefónica al año. Resultados: 3.649 pacientes (81,70% hombres), edad media 54,15 años. ASA II 63,55%. Dolor inmediato en el 85% delos pacientes, que cedió con la analgesia pautada; dolor agudo en el 3%, inyectándose corticoide y anestésico local cuando el dolor no cedía pasadas 4 semanas en 3 pacientes; dolor crónico en el 0% de los pacientes seguidos durante un año. Discusión: Durante el primer mes del postoperatorio sólo están indicados analgésicos orales. Pasado este periodo y ante la permanencia de dolor, u na alternativa a la analgesia pautada puede ser la inyección de corticoide y anestésico local en lazona intervenida. Conclusión: El dolor inmediato tras la hernioplastia inguinal programada en régimen ambulatorio así como el producido en los 3 primeros meses, precisa únicamente analgesia oral. Es nula la prevalencia de dolor crónico en nuestra serie (AU)

Introduction: Chronic pain is pain that persists 3 months after the surgical procedure. Of multifactorial etiology, it can be disabling for the patient. Objetives: To determine, in our environment, the prevalence of chronic pain after inguinal hernioplasty scheduled as ambulatory surgery. Material and methods: A retrospective study of patients diagnosed with inguinal hernia and who underwent ambulatory surgery between January 2000 and December 2006. Immediate pain: at 72hours; severe pain: up to 3 months; chronic pain: more than 3months. Follow-up: telephone call at 24 and 48 hours after discharge, clinical visit one month after and phone call one year later. Results: 3,649 patients (81.70% male), mean age 54.15years. ASA II 63.55%. Immediate pain in the first 48 hours in 85% of patients, which was controlled with analgesia; severe pain in 3%, in which steroids and local anaesthetic injected in 1-2 sessions were given when the pain did not abate after 4 weeks in 3 patients; chronic pain in 0% of the patients followed for one year. Discussion: During the first month after surgery only oral analgesics are indicated. After this period and if there is persistence of pain, an alternative to analgesia may be the injection of corticosteroids and a local anaesthetic. Conclusion: The immediate pain after inguinal hernia in elective and ambulatory surgery as well as until the first 3 months require only oral analgesia. Is zero the prevalence of chronic pain in our series (AU)

Aspectos quirúrgicos de las enfermedades producidas por priones / Surgical aspects of diseases caused by prions

No disponible

Hernia de Spiegel en España. Análisis de 162 casos / Spigelian hernia in Spain. An analysis of 162 cases

No disponible

Laparoscopic cholecystectomy in the treatment of biliary lithiasis: outpatient surgery or short stay unit?

OBJECTIVE: Analysis of clinical and surgical factors in a series of patients subjected to laparoscopic cholecystectomy in an outpatient unit and their relationship with time of discharge and patient acceptance. PATIENTS AND METHOD: Eighty one consecutive patients underwent to elective laparoscopic cholecystectomy during year 2002 within S.A.S. (Andalusian Health Service) from a surgical waiting list. Retrospective and comparative study between two groups: group A includes patients discharged between 24 and 48 hours after intervention; group B includes patients discharged in less than 24 hours. We analyse the clinical and surgical characteristics and post-operative outcome of both groups of patients. RESULTS: Group A was composed of 53 patients and group B of 28 patients. Factors of clinical significance which determined discharge after 24 hours included: early post-surgical incidences or complications (p = 0.017), inability to tolerate oral diet (p = 0.002), and doubts and feelings insecurity of patients regarding discharge by traditional means 62.3% (p = 0.0003). CONCLUSIONS: Outpatient laparoscopic cholecystectomy is a safe and reliable procedure with a high acceptance rate and few complications. Perhaps traditional culture has to be changed to obtain better results.

[Levels of satisfaction and perceived quality in a day surgery unit of a tertiary referral hospital].

INTRODUCTION: Surgical and anesthetic advances have allowed an adequate develop at the day surgery programs, with a rational application and cost-effectiveness of the hospital resorts. The aim of this study, is to know the level of quality perceived in surgical treatment in a program of day surgery. MATERIAL AND METHODS: A randomised selection of 204 patients from a series of 751 operated, between April-May 2001 in a day-surgery institution, was done. Phone questionnaire was done following protocol SERCAL (sociodemographic factors and general satisfaction, accessibility, personal assistance, guarantee and fidelity service) with validation for day surgery programs. Absolute and relatives frequencies were evaluated for dichotomous and categoric variables and medium and standard deviation for numeric variables. Possible differences were evaluated by chi2 test in qualitative variables and Student's t and ANOVA test for quantitative variables. RESULTS: Response index was 70.1%. Satisfaction general index was 9.1%, for 18 numeric items (range 0-10). Social and demographic items show that the best validity of treatment were by elderly, women, retired and low cultural patients. Data reduction by factorial analysis showed 4 factors with incidence (total variance 71.62%): Scientific-technical guarantee service and adequate personal treatment (Cronbach's alpha 0.9060), comfortable and security assistance (Cronbach's alpha 0.8708), accessibility to hospital and professionals (Cronbach's alpha 0.0652), accessibility to surgical service. CONCLUSIONS: General satisfaction of the patients treated in the day-surgery program was high, 9.1 (range 0-10). 88.8% patients would recommend this type of treatment to their parents or friends and in 84.3% would repeat the same experience in the surgery unit. The best appreciate items were the direct treatment and relation, respect, intimacy and information along the assistential circuit by implicated professionals. The worst identified item was the time past in waiting surgical list.

Absceso pancreático drenado en el conducto inguinal / Drainage of pancreatic abscess in the inguinal area

No disponible

[The treatment of upper digestive hemorrhages due to duodenal ulcer by direct hemostasis and vagotomy of the oxyntic cells]. / Tratamiento de las hemorragias digestivas altas por úlcera duodenal mediante hemostasia directa y vagotomía de células oxínticas.

Management of upper gastrointestinal haemorrhage continues to present a challenge in surgical judgment. To evaluate the incidence of rebleeding, ulcer recurrence, mortality and morbidity derived from the surgical technique, we made a prospective study in patients with active bleeding duodenal ulcer (endoscopy diagnosis in all cases), excluding patients with serious intercurrent diseases NSAIDS intake drugs and over seventy years of age. In 49 patients, oxyntic cell vagotomy with undersewing bleeding ulcer were performed in the period 1972-1984. Periodic controls were established, included clinical, radiographic and gastroduodenoscopic evaluation. Five years after operation 35 patients could be evaluated. In these cases, mortality was nil. No early rebleeding was observed. Long term endoscopic results showed only 2.85% of relapses. The results obtained in this study show that oxyntic cell vagotomy with undersewing bleeding ulcer may be a technique of choice in the treatment of bleeding duodenal ulcers and it should be more extensively used in emergency services.