Lichtenstein Repair in Inguinal Hernia- A Retrospective Study on the Impact of In-Hospital Costs of Diabetes Mellitus.

INTRODUCTION: Inguinal hernia is one of the most common conditions in surgical departments and diabetes is known to have a significant impact on both patients' health and healthcare system. The current study aims to evaluate extensively the differences in costs for different subgroups of diabetic patients undergoing inguinal hernia repair in a tertiary care medical center in South-West Romania. MATERIAL AND METHODS: A total number of 195 patients underwent hernia repair for primary or recurrent inguinal hernia between 2015 and 2020 and were included in the analysis. The group was divided into diabetic/non-diabetic patients and each of these subgroups was studied separately according to the presence or absence of comorbidities, sex and place of origin. RESULTS: Statistically significant differences were found in the division of the age group, highlighting the fact that in diabetic patients the average age was around 74.76 years, unlike those without diabetes in which the average age was approximately 61.31 years. Another statistically significant difference was observed in the classification by hospitalization days of the group of patients with incarcerated inguinal hernia, in a sense that diabetic patients required a prolonged hospitalization by 1.5 days as opposed to non-diabetics. CONCLUSIONS: The costs of hospitalization for diabetic patients undergoing hernia repair surgery were marginally higher than in non-diabetic patients, but no statistical difference could be observed between any of the costs subsets in the two patients groups.

Acute lithiasic cholecystitis, pseudoneoplastic form, a cause of conversion for laparoscopic cholecystectomy.

Acute lithiasic cholecystitis represents one of the most frequent pathologies of the digestive tract, most often requiring emergency surgical treatment. The prevalence of this condition increases with age and it affects women the most. Laparoscopic cholecystectomy is the preferred surgical treatment, as it diminishes postoperatory pain, it reduces the hospitalization period and medical and social costs, and it also provides a rapid postoperatory recovery. We present the case of an elder female patient, who presented with complex symptoms and signs, suggesting both lithiasic cholecystitis and a gallbladder neoplastic condition. Although there was preferred a laparoscopic cholecystectomy, the presence of an inflammatory process with intense sclerous reaction in the hepatocystic triangle led the conversion of laparoscopic cholecystectomy into an open, classical one. Due to the inflammatory process, the common bile duct (CBD) could not be explored. The subsequent practicing of a cholangiography on the drain tube highlighted the presence of an obstacle in the end zone of the CBD, which could not be removed until the second surgical intervention. The histopahological exams - from frozen sections to immunohistochemistry - had a crucial role in deciding patient's surgical management. The good evolution of the case and the final postoperatory result confirmed that the therapeutic manner chosen for this case was the appropriate one.