Clinical efficacies of ambulatory surgery for inguinal hernia in 1892 patients

Abstract

Objective To explore the clinical efficacies of ambulatory surgery for inguinal hernia. Methods The clinical data of 1892 patients with inguinal hernia who underwent ambulatory surgery at the West China Hospital of Sichuan University from November 2009 to June 2015 were retrospectively analyzed. Preoperative examinations including blood routine test, blood bio-chemistry checking, blood electrolytes, coagulation convention, pre-transfusion test, blood type, chest X-ray, electrocardiogram were applied to patients. Operation time was rescheduled after abnormal indexes were corrected for elective surgery. Preventive use of antibiotics was not needed. Preperitoneal space tension-free repair or Bassini method was adopted after local infiltration anesthesia. Anesthesia method, operation method, patching material, operation time, number of patients transferred to inpatient department and reasons and treatment expense were recorded. Ambulatory surgery center did satisfaction survey on patients at the discharge. Patients were followed up at postoperative month 1, 3, 6, 12 regularly by the doctor responsible for the surgery till July 2015, including occurrence of complications and chronic pain, recurred hernia, number of readmission and reasons. Measurement data with normal distribution were presented as±s. Results Among 1 892 patients, 1 889 patients underwent operation under local anesthesia and 3 patients were transferred to general anesthesia. There were 1 874 patients undergoing tension-free repair including 1 592 using the material of ultrapro hernia system (UHS), 264 of ultrapro plug (UPP), 8 of prolene hernia system (PHS), 6 of Gore hernia patch, 4 of 3-dimensional plug (3DP), and 18 patients underwent Bassini without preoperativedeath. The operation time of 1 892 patients was (28±12) minutes. Three patients were transferred to inpatient department for postoperative cut incision pain, ecchymoma, abdominal distention after satiation and discharged from hospital after treatment. Among 26 patients with complications after discharge, 12 had superficial incision infection and recovered after dressing change without removal of patches, 5 had edema in scrotum and inguinal region, 3 had ecchymoma, 2 had nausea and vomiting, 2 had urinary retention, 2 had disruption of wound, and they all recovered smoothly after symptomatic treatment. Treatment expense of the 1 892 patients was (6 956±249)yuan per hermia. Satisfaction rate of patients was 99.049%(1 874/1 892) when discharged. The follow-up rate was 86.152%(1 630/1 892). The follow-up time was 1-67 months with a median time of 35 months. During the follow-up, 4 patients had chronic pain and recovered after analgesia and physiotherapy, 3 patients had recurrence of inguinal hernia including 1 case of recurrent hernia and 2 cases of huge hernia. Conclusion Ambulatory surgery for inguinal hernia is safe and effective, with the advantages of few complications, high satisfactory rate and low hospital expenses. Key words: Inguinal hernia; Ambulatory surgery; Efficacy; Quality control