Anestesia subaracnoidea y anestesia general en el tratamiento quirúrgico de la hernia inguinal en pacientes ambulatorios. Análisis comparativo de coste-efectividad / Spinal anesthesia versus general anesthesia in the surgical treatment of inguinal hernia. Cost-effectiveness analysis

Objetivo. Comparar los costes variables en relación con la efectividad clínica de la utilización de anestesia general frente a anestesia subaracnoidea en la cirugía ambulatoria de la hernia inguinal. Material y métodos. Estudio observacional, de cohortes, retrospectivo, con medición y análisis del coste-efectividad, realizado en una unidad de cirugía ambulatoria de un hospital general entre enero de 2010 y diciembre de 2011. Se incluyeron pacientes mayores de 18 años con tratamiento quirúrgico de la hernia inguinal primaria unilateral. Los tiempos de inducción anestésica y permanencia en quirófano y en unidad de recuperación postanestésica, la efectividad anestésica (incidencia de efectos adversos y el grado de bienestar del paciente) y los costes variables asociados al consumo de fármacos y utilización de recursos humanos fueron comparados. Resultados. Se incluyeron 218 pacientes, el 87,2% hombres, con una edad media de 53 años (rango 18 a 85 años). Ciento treinta y nueve (63,76%) pacientes recibieron anestesia subaracnoidea, y 79 (36,2%), anestesia general. La permanencia en recuperación postanestésica fue de 337,6 ± 160,2 min en el grupo de anestesia subaracnoidea y de 210,0 ± 97,5 min para el grupo de anestesia general (p < 0,001). Los costes de los fármacos para anestesia general fueron mayores que para subaracnoidea (86,2 ± 8,3 frente a 18,7 ± 7,2). La diferencia del coste total entre ambas técnicas fue de 115,8 Euros, mayor para el grupo de anestesia subaracnoidea (p < 0,001). Conclusiones. La anestesia subaracnoidea y la general muestran una efectividad similar, pero los costes globales para la primera son mayores que para la segunda. La relación coste-efectividad es más favorable para la anestesia general que para la subaracnoidea en hernioplastia ambulatoria (AU)

Objective. To compare the costs related to the clinical effectiveness of general anesthesia versus spinal anesthesia in inguinal hernioplasty ambulatory surgery. Material and methods. An observational, retrospective cohort study measurement and analysis of cost-effectiveness, in the ambulatory surgery unit of a general hospital. All patients over 18 years of age diagnosed with primary inguinal hernia and scheduled for unilateral hernioplasty between January 2010 and December 2011 were included. Duration of anesthetic induction, length of stay in both the operating room, and in the post-anesthesia care unit, the anesthetic effectiveness (the incidence of adverse effects and the patient's comfort level), and variable economic costs associated with the use of drugs, as well as the use of human resources, were compared. Results. The final analysis included 218 patients, 87.2% male, with a mean age of 53 years (range: 18-85 years). Of these, 139 (63.76%) received subarachnoid anesthesia and 79,(36.2%) general anesthesia. The length of time a patient remained in the post-anesthesia care unit was 337.6 ± 160.2 min in the subarachnoid anesthesia group, and 210.0 ± 97.5 min for the general anesthesia group (P < .001). Costs of drugs for general anesthesia were higher than that for subarachnoid anesthesia (86.2 ± 8.3 vs. 18.7 ± 7.2). The total cost difference between the 2 techniques was Euros 115.8 more for subarachnoid anesthesia (P < .001). Conclusions. Both techniques showed similar effectiveness. The overall costs for subarachnoid anesthesia were greater than for the general. The cost-effectiveness of general anesthesia is better for outpatient inguinal hernia repair surgery (AU)

[Spinal anesthesia versus general anesthesia in the surgical treatment of inguinal hernia. Cost-effectiveness analysis]. / Anestesia subaracnoidea y anestesia general en el tratamiento quirúrgico de la hernia inguinal en pacientes ambulatorios. Análisis comparativo de coste-efectividad.

OBJECTIVE: To compare the costs related to the clinical effectiveness of general anesthesia versus spinal anesthesia in inguinal hernioplasty ambulatory surgery. MATERIAL AND METHODS: An observational, retrospective cohort study measurement and analysis of cost-effectiveness, in the ambulatory surgery unit of a general hospital. All patients over 18 years of age diagnosed with primary inguinal hernia and scheduled for unilateral hernioplasty between January 2010 and December 2011 were included. Duration of anesthetic induction, length of stay in both the operating room, and in the post-anesthesia care unit, the anesthetic effectiveness (the incidence of adverse effects and the patient's comfort level), and variable economic costs associated with the use of drugs, as well as the use of human resources, were compared. RESULTS: The final analysis included 218 patients, 87.2% male, with a mean age of 53 years (range: 18-85 years). Of these, 139 (63.76%) received subarachnoid anesthesia and 79,(36.2%) general anesthesia. The length of time a patient remained in the post-anesthesia care unit was 337.6±160.2min in the subarachnoid anesthesia group, and 210.0±97.5min for the general anesthesia group (P<.001). Costs of drugs for general anesthesia were higher than that for subarachnoid anesthesia (86.2±8.3 vs. 18.7±7.2). The total cost difference between the 2 techniques was €115.8 more for subarachnoid anesthesia (P<.001). CONCLUSIONS: Both techniques showed similar effectiveness. The overall costs for subarachnoid anesthesia were greater than for the general. The cost-effectiveness of general anesthesia is better for outpatient inguinal hernia repair surgery.

Intra-abdominal pulmonary secuestration as an exceptional cause of abdominal mass in the adult.

INTRODUCTION: Pulmonary sequestration (PS) is an extremely rare malformation defined as a portion of lung tissue isolated from the pulmonary system. PSs are classified into intralobar type and intra-abdominal PS that represents only 2.5% of cases. There are 20 cases of PS reported in adults and only two were managed by laparoscopic approach. We report a case of intra-abdominal PS mimicking a gastroesophageal duplication cyst in an adult. Besides its rarity, this is the first intra-abdominal PS in an adult managed by an anterior laparoscopic approach. PRESENTATION OF CASE: A 60-year-old female patient had had epigastric and left upper quadrant pain for several days. Physical examination was normal. Image test were consistent with a gastroesophageal duplication. The patient was taken to the operating room for laparoscopic exploration and resection. The pathological diagnosis was extralobar pulmonary sequestration. DISCUSSION: Less than 20 cases of PS have been reported in adults and only two cases were managed by a lateral laparoscopic approach. In contrast to these reports, we used an anterior approach due to the GEJ suspected origin of the mass. CONCLUSION: Extralobar intra-abdominal PS is an extremely rare condition during adulthood but this diagnosis should be included in the differential diagnosis of a left-sided suprarenal mass. Due to the difficulty in achieving a definitive preoperative diagnosis, surgery is recommended. Laparoscopic resection is safe and effective but careful preoperative imaging studies are recommended in order to plan the most suitable approach.

Pelvic reconstruction after abdominoperineal resection: a pilot study using an absorbable synthetic prosthesis.

BACKGROUND: Abdominoperineal resection (APR) is not free of complications, in particular complications due to the occupation of the pelvis by the small bowel after surgery. A number of surgical techniques have been described to prevent the small bowel from entering and adhering to the pelvis (pelvic partition), but there is no agreement concerning their use. The aim of this study was to evaluate the feasibility, effectiveness and safety of using an absorbable synthetic prosthetic material for pelvic partitioning after APR. METHODS: A prospective non-randomised longitudinal pilot study was carried out on a series of 10 patients who underwent APR due to lower-third rectal cancer, in order to evaluate the feasibility, safety and efficacy of pelvic partitioning with an absorbable synthetic prosthetic material. RESULTS: In all the patients, it was possible to perform a radical resection and to install the prosthesis. After a mean follow-up of 9 months (range: 4-18 months), no abdominal or perineal complications were detected. One patient (10%) suffered chronic pelvic pain. CONCLUSIONS: Pelvic partition after APR of the rectum with an absorbable synthetic prosthesis is feasible, effective and safe.