6 dr mg-bhat-ambulatory-hernia-surgery_ncas_2011
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Ambulatory Hernia Surgery
1
National Ambulatory Surgery, Sept 2011, Bangalore 1
Dr. M G Bhat MS, FRCS(England), FRCS ( Edinburgh), FICS, DMLE (Law), DMIRCSEd (Informatics)
Consultant Surgeon, Bangalore Medical Director, Nova Medical Centers Ltd, India
Greetings From…
©2009. Nova Medical Centers. Strictly private and confidential
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 2
Evaluation of Hernia Repair
in Ambulatory Surgery
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 3 [email protected]
Data : March 2010–August 2011 Total Hernia Repairs: 88
Hernia Lap Open Total M:F=71:17
Inguinal 43 23 66 65:1
Umbilical 6 13 19 6:13
Incisional 1 2 3 0:3
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 4 [email protected]
Open TEP TAPP Total Repairs
Single 21 4 2 27 27
Bilateral 2 34 3 39 78
Total 23 38 5 66 105
GA 11 38 5 54
LA 12 0 0 12
Stay : 6-14hrs ( 1 over night)
Data : March 2010–August 2011 66 patients underwent Inguinal Hernia Repair (105)
Data Authenticated by the UBQ systems of Nova Medical Centers Pvt Ltd, India
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 5 [email protected]
Appointment
Comes to Center
Surgery
Shifted to Post op
Discharge
Telephonic Check
Follow up In OPD
OPD Assessment
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 6 [email protected]
Anesthesia and Analgesia In Day Care Surgery
•GA •LA •Regional
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 7 [email protected]
Anesthesia and Analgesia
•Short Acting Relaxants •Total Avoidance of Sedatives/Narcotics •Analgesics –
IV Paracetamol NSAIDs Paracetamol Tramdol Proxyvon
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 8 [email protected]
Anesthesia and Analgesia
Local Anesthesia
Layer by Layer Anesthesia Xylocaine 2% - 20ml Sensorcaine 0.5% -10ml Adrenaline 1:200000 - 20ml Hylase -
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 9 [email protected]
• Selected from Out Patient • General Status • Size of Hernia • No Major Co Morbid Conditions • Social Background/Help at Home • Psychological Status • Anesthetic Clearance • Doctors Comfort
Selection Criteria
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 10 [email protected]
Problems Haematoma-1 Ur Retention-1
Hernia Lap Open Total Stay
Inguinal 43 23 66 One overnight stay
Umbilical 6 13 19 Two overnight stay
Incisional 1 2 3 2 stayed 48hrs
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 11 [email protected]
Stand Alone Ambulatory
Surgical Centers
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 12 [email protected]
• Doctor Acceptance • Patient Selection • Patient Acceptance • Patient Counseling • Anesthetic Support • Pain Management • Home Care
Ambulatory Surgery
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 13 [email protected]
•Well Streamlined Service •No delays •Anesthesia •Analgesics •Financial Benefits •Satisfaction
Service and Outlook Differences
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 14 [email protected]
J. of Ambulatory Surgery 12 (2006) 167–171 Evaluation of inguinal hernia in ambulatory surgery: A prospective monocentric study on 1009 inguinal hernia E. Jacquet a,∗, P. Puche a, J. Alahyane a, et all
Literature Review - Pubmed
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 15 [email protected]
Ann Surg. 1999 Nov;230(5):721-7. Return hospital visits and hospital readmissions after ambulatory surgery. Mazel G, Chung F, Department of Anaesthesia, Toronto Western Hospital, University of Toronto, Ontario, Canada.
Literature Review - Pubmed
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 16 [email protected]
Surg Endosc. 2006 Jan;20(1):76-81 Day-case endoscopic totally extraperitoneal inguinal hernioplasty versus open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males: a randomized trial. Lau H, Patil NG, Yuen WK
Ann R Coll Surg Engl. 2010 Mar;92(2):127-30. Over a thousand ambulatory hernia repairs in a primary care setting. Dhumale R, Tisdale J, Barwel N .
Literature Review - Pubmed
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 17 [email protected]
Surg Endosc. 2003;17:49149-49153 Day-case Laparoscopic Hernia Repair in a Single Unit, McCloud JM, Evans DS Laparoscopic groin hernia repairs on 769 patients, 218 had bilateral repairs
Literature Review - Pubmed
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 18 [email protected]
Day Care Surgery
•Unfit Patients (co morbid conditions) •Large Hernias •Emergency Hernias •Requiring More Days of Stay •Psychologically Unsuitable •No Help to Take care at home •Doctors Comfort
Not Suitable
Ambulatory Hernia Surgery
National Ambulatory Surgery, Sept 2011, Bangalore 19
Thank you