Outpatient treatment of abdominal wall hernia. A strategy to reduce the impact of the COVID-19 pandemic.

AIM: The aim of this study is to demonstrate the feasibility and efficacy of the treatment of abdominal wall hernias in ambulatory setting in selected patients to break down long waiting lists due to the COVID 19 pandemic. METHODS: From February to June 2021, we performed 120 hernia repair operations with local anesthesia in ambulatory settings without anesthetists. (105 inguinal hernia, 6 femoral hernia and 9 umbilical hernia). All patients were selected from our waiting lists first through a telephone interview through an adequate collection of the anamnesis and then clinically (LEE index and ASA score) and based on the characteristics of the hernia. RESULTS: For all patients, the operation was performed under local anesthesia with lidocaine and naropine. Lichtenstein tension-free mesh repair were performed for all patients with inguinal hernia; polypropylene mesh-plug was the technique used to repair the crural hernias while a direct plastic was performed for the treatment of umbilical hernias.. The mean age was 58 years. We did not observe any intraoperative complications and patients were discharged after 4 hours of operation. There was no case of readmission. Only 3 (2.5%) patients developed scrotal bruising. We did not observe any other complications or recurrence at 30 days and 6 months. Most patients (97.5%) expressed satisfaction for local anesthesia and for the path created. CONCLUSION: Hernia pathologies could be treated in ambulatory setting with good results in selected patients and could represent an alternative to face the limitations imposed by the COVID pandemic on daily surgical activities. KEY WORDS: Ambulatory surgery Cocid-19 Epidemic,Wall hernia.

Barbed versus traditional suture for enterotomy closure after laparoscopic right colectomy with intracorporeal mechanical anastomosis: a case-control study.

Our aim was to establish the safety and efficacy of barbed suture for enterotomy closure after laparoscopic right colectomy with intracorporeal anastomosis. This study included 47 patients who underwent laparoscopic right hemicolectomy with intracorporeal mechanical anastomosis and barbed suture enterotomy closure (barbed suture closure-BSC) for adenocarcinoma (with the exception of T4 lesions and metastasis), compared with 47 matched patients who underwent laparoscopic right hemicolectomy with intracorporeal mechanical anastomosis and conventional suture enterotomy closure (conventional suture closure-CSC) during the same period. Controls were matched for stage, age, and gender via a statistically generated selection of all laparoscopic right hemicolectomies performed from January 2009 until December 2015. There was no difference between the two groups in terms of age, sex, BMI, ASA, co-morbidity, previous abdominal surgery, cancer site and cancer staging. In terms of operating time (median 120 min for BSC and 127.5 min for CSC), histopathological results, surgical site complications (2.1% for BSC and 8.5% for CSC), hospitalization (median 6 days for BSC and 5 days for CSC), readmission rate (0%), there were no differences between the groups (p > 0.05). No significant differences were noted between the two groups in terms of the postoperative course. Our results support that the use of knotless barbed sutures for enterotomy closure after laparoscopic right colectomy with intracorporeal mechanical anastomosis is safe and reproducible.