Dabić Dejan, Perunicić Vladan, Marić Biljana
Department of Surgery, General Hospital Cacak, Serbia.
Acta Chir Iugosl. 2012;59(1):87-93.
Ambulatory surgery refers to hospitalization that does not exceed 24 hours, during which a surgical procedure is performed. Inguinal hernia repairs done under local anaesthesia on an outpatient basis are no longer performed exclusively in specialized hernia centers. They are becoming widely accepted by surgeons working in district hospitals, which was significantly contributed to by the publication of the EHS Guidelines on the Treatment of Inguinal Hernia.
The objective of this retrospective study is to show local anaesthesia practicability for inguinal hernia repairs through "one -step procedure", being a one-day procedure used in District General Hospital.
From January 2006 to June 2011, 460 elective surgery procedures were performed on 428 patients with inguinal hernia (396 with unilateral and 32 with bilateral inguinal hernia), using Lichtenstein technique, UHS/PHS, plug repair, and Shouldice technique. All the proceduress were performed under local anaesthesia by the same surgeon using "one-step procedure" in ambulatory surgery. The following anaesthetics were used: Lidocaine for intradermal and subcutaneous anaesthesia as well as Bupivacaine/Levobupivacaine for subfascial anaesthesia.
From January 2006 to June 2011, 460 surgical procedures were performed on 428 patients with inguinal hernia (396 with unilateral and 32 with bilateral inguinal hernia). The mean age was 58.2 yrs (20-84). All the patients were in the ASA I-III group. In unilateral hernias, the mean operating time using Lichtenstein technique was 38mins (28-56), using PHS/UHS 28mins (22-40), with plug 33mins (27-39) and using Shouldice technique 43mins (32-53). In bilateral hernias, the mean operating time using Lichtenstein technique was 71mis (56-87), and using PHS /UHS 56mins (49-64). The mean hospital stay was 2.9hrs (2-6). The mean distance of residence from the hospital was 23km (1-150). During the course of the surgery, 15 patients (3.5%) had problems such as pain, bradycardia, hypotension, or perspiration. The complications during the mean follow-up of 31 months (1-60) was: 1.4% (6 patients)--a hematoma, 1.87% (8 patients)--seroma, 0.47% (2 patients)--wound infection, 0.23% (1 patient)--chronic pain, and 0.47% (2 patients)--recurrence. Revision due to active bleeding was conducted in two patients (0.47%), after using PHS and Lichtenstein techniques. These were the only patients who were rehospitalized due to complications.
In hernia repairs on an outpatient basis, "one-step procedure" in local anaesthetic administration is reliable, easy, safe, effective, and the type of the surgical technique is not a determining factor. The success rate and treatment outcome depend on the surgical technique and the surgeon's experience in using local anaesthesia in ambulatory surgery.
门诊手术是指不超过24小时的住院治疗，期间进行外科手术。在门诊进行的局部麻醉下腹股沟疝修补术不再仅在专门的疝中心开展。地区医院的外科医生也越来越广泛地接受这种手术，《欧洲疝学会腹股沟疝治疗指南》的发布对此起到了显著的推动作用。
本回顾性研究的目的是通过“一步法”展示腹股沟疝修补术在局部麻醉下的可行性，“一步法”是地区综合医院采用的一种一日手术方法。
2006年1月至2011年6月，对428例腹股沟疝患者（396例单侧腹股沟疝和32例双侧腹股沟疝）进行了460例择期手术，采用Lichtenstein技术、UHS/PHS、补片修补和Shouldice技术。所有手术均由同一位外科医生在门诊手术中采用“一步法”在局部麻醉下进行。使用的麻醉剂如下：利多卡因用于皮内和皮下麻醉，布比卡因/左旋布比卡因用于筋膜下麻醉。
2006年1月至2011年6月，对428例腹股沟疝患者（396例单侧腹股沟疝和32例双侧腹股沟疝）进行了460例手术。平均年龄为58.2岁（20 - 84岁）。所有患者均属于ASA I - III组。在单侧疝中，采用Lichtenstein技术的平均手术时间为38分钟（28 - 56分钟），采用PHS/UHS为28分钟（22 - 40分钟），采用补片为33分钟（27 - 39分钟），采用Shouldice技术为43分钟（32 - 53分钟）。在双侧疝中，采用Lichtenstein技术的平均手术时间为71分钟（56 - 87分钟），采用PHS/UHS为56分钟（49 - 6)4分钟）。平均住院时间为2.9小时（2 - 6小时）。患者住所到医院的平均距离为23公里（1 - 1)50公里）。在手术过程中，15例患者（3.5%）出现疼痛、心动过缓、低血压或出汗等问题。平均随访31个月（1 - 60个月）期间的并发症为：1.4%（6例患者）——血肿，1.8)7%（8例患者）——血清肿，0.47%（2例患者）——伤口感染，0.23%（1例患者）——慢性疼痛，0.47%（2例患者）——复发。采用PHS和Lichtenstein技术后，有2例患者（0.47%）因活动性出血进行了翻修手术。这是仅有的因并发症再次住院的患者。
在门诊疝修补术中，局部麻醉给药的“一步法”可靠、简便、安全、有效，手术技术类型不是决定因素。成功率和治疗效果取决于手术技术以及外科医生在门诊手术中使用局部麻醉的经验。
