INTRODUCTION: In our department of General Surgery and Oncological Surgery, a unit of ambulatory surgery was instituted in January 1994, with the aim of reducing the waiting list and healthcare costs. METHODS: From January 1994 to October 1998, we operated in day-surgery 681 patients (536 males, mean age 56.3 and 145 females, mean age 48.8): 352 had indirect inguinal, 132 direct inguinal, 41 scrotal, 75 recurrent, 38 femoral, 32 umbilical and 12 epigastric hernias. At the day of the operation, a short term antibiotic prophylaxis 30 minutes before the operation was applied. One hundred and forty-four patients (21.6%) were submitted to epidural, 529 pts (77.7%) to local and 8 pts (1.2%) to general anesthesia. We used a modified Lichtenstein procedure which consisted of suturing the polypropylene mesh to Cooper’s ligament in treatment of the inguinal hernia. We put moreover a polypropylene plug into the internal inguinal ring, when dilated more than 2 cm, and always in recurrent hernias. A duplication of the transverse abdominal aponeurosis was done in all direct hernias, with apposition of a patch and occasionally a plug. In femoral hernias we put a plug in femoral approach and plug mesh in the inguinal approach. In umbilical and epigastric hernias we set the mesh beneath the fascia. Visits at 3, 7 days, 3 months and 1 year after operation. RESULTS: Eight patients were converted to general anesthesia, due to local anesthesia intolerance. At 58th month follow up, we report 93.9% success rate. Post-operative complications rate were 6.0%: 4 seromas, 13 wound hematomas, 15 cases of neuritic pain and 2 orchitis, which healed after medical treatment. We observed moreover 5 recurrent inguinal hernias (due to mesh dislocation) and 2 homolateral femoral hernias, occurring 6 months after the operation. It was the first year of our experience when we also used the Trabucco procedure. Since then we have always used modified Lichtenstein procedure, applying a single stitch to connect the mesh to the Cooper’s ligament. CONCLUSION: Our results are excellent with index of satisfaction very good (98.8%). Further this technique reduces the phycological stress with less post-operative discomfort and allows an early return to daily occupation.
|Titolo:||The surgical treatment of abdominal wall hernias in day surgery: 5 years of experience|
MOZZI, ENRICO STEFANO MARIA (Penultimo)
|Settore Scientifico Disciplinare:||Settore MED/18 - Chirurgia Generale|
|Data di pubblicazione:||1999|
|Appare nelle tipologie:||01 - Articolo su periodico|