ABSTRACT
The efficacy of a surgical procedure is a measure of outcome when performed by specialists. The monotonous excellence of countless cohort studies bears witness to the efficacy of numerous techniques of herniorrhaphy. Effectiveness, however, is of far greater relevance to health care commissioners than efficacy. Audit is an instrument of effectiveness and can be further developed to study cost-effectiveness where outcomes do not differ greatly.
Subject(s)
Hernia, Inguinal/surgery , Medical Audit , Ambulatory Surgical Procedures/adverse effects , Ambulatory Surgical Procedures/economics , Ambulatory Surgical Procedures/methods , Europe , Humans , Laparoscopy/adverse effects , Laparoscopy/economics , Laparoscopy/methods , Referral and Consultation/statistics & numerical data , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/economics , Surgical Procedures, Operative/methods , Surveys and Questionnaires , Time Factors , Treatment Outcome , Waiting ListsABSTRACT
The trend towards shorter hospital in-patient stays has decreased the availability of patients for undergraduate medical student teaching. We surveyed 100 consecutive short stay surgical inpatients admitted to hospital on the day of planned operation to determine whether they might be available for student teaching before surgery. We found that there was a median delay of three hours (standard deviation +/-2.3 hours) between the completion of all medical and nursing procedures and the departure of the patient for the operating theatre. All patients were asked if they would agree in principle to participate in student teaching. 98 per cent said they would be willing to be taught upon. We argue that surgical patients attending the short stay ward are a valuable potential source of teaching material.
Subject(s)
Education, Medical, Undergraduate/organization & administration , General Surgery/education , Hospital Units/statistics & numerical data , Inpatients , Length of Stay , Humans , London , Medical Staff, Hospital/education , Time FactorsABSTRACT
There are no objective data available on the relative strengths of inguinal hernia repairs. The aim of this randomized controlled study was to measure th force required to disrupt laparoscopic and open mesh repairs in a porcine model. Eleven pigs had inguinal hernia repair following randomization to an open mesh group (n = 5) or a transabdominal preperitoneal laparoscopic group (n = 6). Four weeks after operation the pigs were killed and the pelvic girdles were mounted in a test jig on a mechanical testing machine. The applied disruption forces were measured and recorded. Mean(s.d.) force required to disrupt the normal inguinal canal (n = 11) was 68.6(30.1) N with no difference between groups. The open mesh repair required 110.3(41.4) N and the laparoscopic mesh 220.0(95.2) N. Both open and laparoscopic mesh repairs were stronger than the normal side (P < 0.03). The laparoscopic mesh repair was stronger than the open mesh repair (P = 0.04). This model provides a standardized method for mechanically testing inguinal hernia repairs in pigs. It confirms that both open and laparoscopic mesh hernia repairs are stronger than the non-herniated normal side at 4 weeks after operation. Laparoscopic mesh repair is stronger than open mesh repair. The weakest points of the repairs correlate well with those identified in clinical reports.
