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
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©2009. Nova Medical Centers. Strictly private and confidential

2. Ambulatory Hernia Surgery
Evaluation of
Hernia Repair
in
Ambulatory Surgery
drmgbhat@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 0:3
drmgbhat@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, India
drmgbhat@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 OPD
drmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 5

6. Ambulatory Hernia Surgery
Anesthesia and Analgesia
In Day Care Surgery
•GA
•LA
•Regional
drmgbhat@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
Proxyvon
drmgbhat@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 Comfort
drmgbhat@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 48hrs
drmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 10

11. Ambulatory Hernia Surgery
Stand Alone
Ambulatory
Surgical Centers
drmgbhat@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 Care
drmgbhat@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
•Satisfaction
drmgbhat@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 all
drmgbhat@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 WK
drmgbhat@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 repairs
drmgbhat@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 Comfort
drmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 18

19. Ambulatory Hernia Surgery
Thank you
drmgbhat@novamedicalcenters.com National Ambulatory Surgery, Sept 2011, Bangalore 19