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6 dr mg-bhat-ambulatory-hernia-surgery_ncas_2011

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  • 1. Ambulatory Hernia Surgery Greetings From… Dr. M G Bhat MS, FRCS(England), FRCS ( Edinburgh), FICS, DMLE (Law), DMIRCSEd (Informatics) Consultant Surgeon, Bangalore Medical Director, Nova Medical Centers Ltd, India drmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 1 1 ©2009. Nova Medical Centers. Strictly private and confidential
  • 2. Ambulatory Hernia Surgery Evaluation of Hernia Repair in Ambulatory Surgerydrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 2
  • 3. Ambulatory Hernia Surgery 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 0:3drmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 3
  • 4. Ambulatory Hernia Surgery Data : March 2010–August 2011 66 patients underwent Inguinal Hernia Repair (105) 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 Authenticated by the UBQ systems of Nova Medical Centers Pvt Ltd, Indiadrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 4
  • 5. Ambulatory Hernia Surgery OPD Assessment Appointment Comes to Center Surgery Shifted to Post op Discharge Telephonic Check Follow up In OPDdrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 5
  • 6. Ambulatory Hernia Surgery Anesthesia and Analgesia In Day Care Surgery •GA •LA •Regionaldrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 6
  • 7. Ambulatory Hernia Surgery Anesthesia and Analgesia •Short Acting Relaxants •Total Avoidance of Sedatives/Narcotics •Analgesics – IV Paracetamol NSAIDs Paracetamol Tramdol Proxyvondrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 7
  • 8. Ambulatory Hernia Surgery Anesthesia and Analgesia Local Anesthesia Layer by Layer Anesthesia Xylocaine 2% - 20ml Sensorcaine 0.5% -10ml Adrenaline 1:200000 - 20ml Hylase -drmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 8
  • 9. Ambulatory Hernia Surgery Selection Criteria • Selected from Out Patient • General Status • Size of Hernia • No Major Co Morbid Conditions • Social Background/Help at Home • Psychological Status • Anesthetic Clearance • Doctors Comfortdrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 9
  • 10. Ambulatory Hernia Surgery Haematoma-1 Problems 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 48hrsdrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 10
  • 11. Ambulatory Hernia Surgery Stand Alone Ambulatory Surgical Centersdrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 11
  • 12. Ambulatory Hernia Surgery Ambulatory Surgery • Doctor Acceptance • Patient Selection • Patient Acceptance • Patient Counseling • Anesthetic Support • Pain Management • Home Caredrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 12
  • 13. Ambulatory Hernia Surgery Service and Outlook Differences •Well Streamlined Service •No delays •Anesthesia •Analgesics •Financial Benefits •Satisfactiondrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 13
  • 14. Ambulatory Hernia Surgery Literature Review - Pubmed 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 alldrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 14
  • 15. Ambulatory Hernia Surgery Literature Review - Pubmed 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.drmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 15
  • 16. Ambulatory Hernia Surgery Literature Review - Pubmed 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 . 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 WKdrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 16
  • 17. Ambulatory Hernia Surgery Literature Review - Pubmed 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 repairsdrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 17
  • 18. Ambulatory Hernia Surgery Day Care Surgery Not Suitable •Unfit Patients (co morbid conditions) •Large Hernias •Emergency Hernias •Requiring More Days of Stay •Psychologically Unsuitable •No Help to Take care at home •Doctors Comfortdrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 18
  • 19. Ambulatory Hernia Surgery Thank youdrmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 19