Short term clinical outcomes following elective day care primary inguinal hernia repair in Mulago hospital
Abstract
Description
A dissertation submitted to the Graduate School in partial fulfillment of the requirements for the award of a degree of Master of Medicine in Surgery of Makerere University
BACKGROUND: Day surgery is steadily growing all over the world. In Uganda, this modality of surgery will expand. Known for its cost friendly approaches, improving surgical outputs and relieveing the burden of disease, day surgery is of great benefit to Uganda. Inguinal hernia is one of the commonest surgical conditions often operated on as either outpatient or inpatient cases in mulago hospital. This study was done to evaluate the clinical outcomes of day care primary inguinal hernia repair in Mulago hospital. OBJECTIVE: To asses the clinical outcomes of day care elective primary inguinal hernia repair in mulago hospital. DESIGN: A prospective case series SETTING: Surgical outpatients department, mulago hospital. METHODS: In this study, 123 adult patients with a primary inguinal hernia were received in the surgical outpatient’s clinic between October 2006 and March 2007. Twenty were not eligible for the study. One hundred and three patients were operated on as day cases in the surgical outpatient’s theater under local anesthesia. The participants were observed for a minimum of 2 hours and then allowed to go home. Neither was admitted on the day of surgery nor in the course of follow up. During recovery, the principle investigator communicated with the participants for follow up. Returning on the7th postoperative day, stitch removal was done with final reviews and discharge from the study on the 14th postoperative day. RESULTS: A Total of 103(81.3%) patients had day care hernia repair. Three patients were lost to follow up. The results presented are based on 100 patients that were followed to the 14th post operative day. Among the participants, 97(97%) had normal wound healing, only 3(3%) developed wound complications, three(3%) had post operative nausea, 98(98%) were satisfied with the procedure and two(2%) were not. Pain scores were determined using the visual analog scale. On the 7th day at rest the scores were 0(87%), 1(10%), and 7(3%). On movement, 0(61%), 1(17%), 2(9%), 3(10%) and 8(3%). On the 14th day, the scores at rest were 0(97%), 2(2%), 3(1%). On movement, 0(97%), 3(2%) and 4(1%). Generally 92% of the participants had a good outcome while 8% had a bad outcome. CONCLUSION: Day adult hernia surgery was found to be safe and acceptable to a majority of patients. In this study, 81.3% of the adult primary inguinal hernias were operated on as day cases. Ninety two percent of the patients with primary inguinal hernia treated as day cases had a good outcome while 8% had a bad outcome. RECOMMENDATIONS: Adult day inguinal hernia repair should be promoted in Mulago hospital.
BACKGROUND: Day surgery is steadily growing all over the world. In Uganda, this modality of surgery will expand. Known for its cost friendly approaches, improving surgical outputs and relieveing the burden of disease, day surgery is of great benefit to Uganda. Inguinal hernia is one of the commonest surgical conditions often operated on as either outpatient or inpatient cases in mulago hospital. This study was done to evaluate the clinical outcomes of day care primary inguinal hernia repair in Mulago hospital. OBJECTIVE: To asses the clinical outcomes of day care elective primary inguinal hernia repair in mulago hospital. DESIGN: A prospective case series SETTING: Surgical outpatients department, mulago hospital. METHODS: In this study, 123 adult patients with a primary inguinal hernia were received in the surgical outpatient’s clinic between October 2006 and March 2007. Twenty were not eligible for the study. One hundred and three patients were operated on as day cases in the surgical outpatient’s theater under local anesthesia. The participants were observed for a minimum of 2 hours and then allowed to go home. Neither was admitted on the day of surgery nor in the course of follow up. During recovery, the principle investigator communicated with the participants for follow up. Returning on the7th postoperative day, stitch removal was done with final reviews and discharge from the study on the 14th postoperative day. RESULTS: A Total of 103(81.3%) patients had day care hernia repair. Three patients were lost to follow up. The results presented are based on 100 patients that were followed to the 14th post operative day. Among the participants, 97(97%) had normal wound healing, only 3(3%) developed wound complications, three(3%) had post operative nausea, 98(98%) were satisfied with the procedure and two(2%) were not. Pain scores were determined using the visual analog scale. On the 7th day at rest the scores were 0(87%), 1(10%), and 7(3%). On movement, 0(61%), 1(17%), 2(9%), 3(10%) and 8(3%). On the 14th day, the scores at rest were 0(97%), 2(2%), 3(1%). On movement, 0(97%), 3(2%) and 4(1%). Generally 92% of the participants had a good outcome while 8% had a bad outcome. CONCLUSION: Day adult hernia surgery was found to be safe and acceptable to a majority of patients. In this study, 81.3% of the adult primary inguinal hernias were operated on as day cases. Ninety two percent of the patients with primary inguinal hernia treated as day cases had a good outcome while 8% had a bad outcome. RECOMMENDATIONS: Adult day inguinal hernia repair should be promoted in Mulago hospital.
Keywords
Elective surgery, Primary inguinal hernia repair, Mulago Hospital, Day care surgery Uganda Hernia Inguinal region