Early outcome and feasibility of ambulatory inguinal herniorrhaphy in single institute
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Abstract
Abstract
Background: Inguinal hernia is one of common surgical diseases in Thailand and conventionally treated by in-patient surgery. Over two decades, ambulatory or one-day herniorrhaphy has been proved to be an alternative standard approach and gained more acceptance due to the same outcome.
Objectives: This study intent to determine the success rate and feasibility of ambulatory or day-case hernia surgery in our center. The Lichtenstein repair under local anesthesia (ambulatory group) was compared to conventional approach (control group) which repair under spinal or general anesthesia.
Materials & Methods: This study was designed as prospective cohort study by enrollment of all patients with unilateral inguinal hernia who obtained surgery between October 2018 to April 2019. The inclusion criteria were adult patients with Nyhus classification 1-3B with voluntary consent that were purposive sampling assigned to either ambulatory group or conventional groups by surgeon preference technique. Ambulatory hernia protocol composed of preemptive pain control, local inguinal nerve block, optional deep sedation and post anesthetic discharge score (PADS) evaluation before discharge. The predetermined PADS score higher than 9 was the criteria for hospital discharge. Outcome variables included duration of surgery, early postoperative complication, hospital cost, resumed normal activities and 30-day complication.
Results: Ambulatory group composed of 29/125 patients (23.2%) that 93.1% of this group were discharged within the same day. Failure of two cases caused by a low PADS score and an asthmatic attack necessitated overnight observation. Compare to conventional group, the ambulatory group are younger (p = 0.012), shorter operative time (75 vs 90 mins, p = 0.005), faster resumed daily activities (5 vs 7 days, p < 0.001) were observed without significant differences in early complication and hospital cost.
Conclusion: This study was evidence to prove the safety and cost-effectiveness of ambulatory inguinal herniorrhaphy in our hospital.
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References
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