Improved functional outcome and more rapid return to normal activity following laparoscopic hernia repair.

BACKGROUND: The laparoscopic repair of inguinal hernias remains a controversial subject. Advantages in terms of reduced postoperative pain and improved functional status have been demonstrated in some studies and refuted in others. We performed a prospective study of a group of young healthy patients to measure pain levels and time to return to normal activity following totally extraperitoneal laparoscopic (TEP) hernia repair and compared these outcomes to those seen following conventional anterior repair. METHODS: A total of 151 patients were entered into a prospective nonrandomized study. Forty-eight patients underwent anterior repair; 103 underwent TEP repair. Patients were followed at 2 and 6 weeks to assess their level of function on a five-point scale. Their use of pain medication was also assessed, and total days away from work and days until return to full activity were documented. RESULTS: The open group returned to work at 11.5 days and to full activity at 26.7 days. The TEP group returned to work at 6.4 days and to full activity at 14.2 days (p < 0.001 for both data). There was no statistically significant difference in the use of pain medication. The TEP group reported better functional status at 2 weeks than the open group. At 6 weeks, this difference was no longer statistically significant. CONCLUSION: As compared to conventional open repair, TEP hernia repair offers advantages in postoperative function and an earlier return to full activity.

Outpatient laparoscopic cholecystectomy: what predicts the need for admission?

Laparoscopic cholecystectomy (LC) is commonly performed as an outpatient (OP) procedure in selected patients, either in ambulatory surgery units associated with a hospital or in freestanding facilities. To identify factors that may preclude OPLC, a retrospective analysis of all patients who underwent LC by two surgeons from August 1996 through June 1998 was performed. A total of 126 patients were divided into three groups. Group I comprised 102 patients who underwent attempted elective OPLC. Group II comprised 20 patients who underwent LC on an emergent basis. Group III comprised 5 patients who were admitted before LC. Data were gathered regarding patient demographics, preoperative diagnoses, preoperative laboratory values, length of stay after surgery, and complications. These data were analyzed using logistic regression and univariate analysis. Age >60 and American Society of Anesthesiologists (ASA) class >2 appeared to be significant predictors of admission, but when considered together, neither was significant. The diagnosis of acute cholecystitis or biliary pancreatitis was highly predictive of admission in both groups. An ASA class >2 did predict postoperative stay of more than 12 hours. These data suggest that OPLC can be performed safely in unselected patients. However, those patients with an ASA class >2 or with a diagnosis of biliary pancreatitis or acute cholecystitis are more likely to require admission or postoperative stay over 12 hours, and these criteria should be considered relative contraindications to OPLC in free-standing facilities.