Hernioplasty in one-day surgery

Hernija označava izbočenje sadržaja kroz prirođeni ili stečeni defekt. Najučestalije su ingvinalne hernije. Zbrinjavaju se kirurški, na dva temeljna načina; herniorafijom ili hernioplastikom. Zahvati se izvode u sklopu višednevnog bolničkog programa ili u okviru jednodnevne kirurgije. Jednodnevna kirurgija označava pružanje kirurških postupaka bez potrebe za hospitalizacijom. Hernioplastike su jedna od najčešće izvođenih operacija u jednodnevnoj kirurgiji (30% do 80%). Ovaj diplomski rad analizira više kriterija predoperativnog odabira bolesnika, te uspoređuje njihovu sigurnost prema pojavi postoperativnih komplikacija. Obuhvaćeno je 590 bolesnika kojima je tijekom 2015. godine urađena hernioplastika na KBC-u Zagreb. Na Zavodu za jednodnevnu kirurgiju operirano je 226 bolesnika, dok je 354 bilo liječeno u okviru višednevnog bolničkog programa. Većina bolesnika dječje dobi (0-18), te starije dobi (>74), operirana je u bolničkim uvjetima. Bolesnici između 19-49 godina su dominantno operirani u jednodnevnoj kirurgiji. Bolesnici operirani u jednodnevnoj kirurgiji su najvećim djelom bili ASA I (53%), dok su bolnički operirani bolesnici većinom bili ASA II statusa (51.7%). Većina bolesnika s ASA III je zbrinjavana u bolničkom programu (20.7%). U skupini bolnički operiranih, najzastupljenija je bila opća anestezija (94.6%), a u skupini jednodnevne kirurgije lokalna anestezija (68%). Vrijeme čekanja do operacije je bilo kraće za bolesnike jednodnevne kirurgije (63% bolesnika je čekalo do 5 tjedana). Učestalost poslijeoperativne infekcije (2 %) i boli (8%) je bila vrlo niska u obje skupine, te nije postojala statistički značajna razlika između njih. Recidiv se s neznatnom razlikom nešto češće pojavljivao u skupini bolnički liječenih (8.7%). Hematomi i seromi pojavljivali su se po istom obrascu; vrlo rijetko (1-1.5 %) i bez razlika između skupina. Podjednako mali broj ranih komplikacija i recidiva govori kako su obje skupine liječene na siguran način, a izbor načina liječenja je bio primjeren.Hernia is a protrusion of an internal part of the body through the defect in the muscle or tissue wall. Inguinal hernias are the most common type. Treatment is surgical. There are two main methods; herrnioraphy and hernioplasty. Procedures can be done in inpatient or one-day surgery. One-day surgery is a surgery that does not require an overnight hospital stay. Hernia repairs are one of the most frequent procedures that are performed in one day-surgery (30% to 80%). The aim of this study was to evaluate the criteria for preoperative patient selection and compare safety in the manner of postoperative complications. Five hundred and ninety patients who underwent surgical repair of inguinal hernia at the University Hospital Centre Zagreb in 2015 were analyzed. 226 of them were treated at the Department of One-day Surgery, and 354 were treated at the main Surgical Department. Most patients of child age (0-18), as well as elderly patients (>74) were treated at Surgical Department. Patients between 19 and 49 years were dominantly managed at the Department of One-day Surgery. Hospitalized patients were mainly ASA II (51.7%), while one-day surgery patients were ASA I (53%). The ones with ASA III were mostly treated at main Surgical Department (20.7%). The greatest number of patients at the Surgical Department underwent surgery under general anesthesia (94.6%). In contrast, patients from one-day surgery underwent surgery mostly under local anesthesia (68%). The percentage of patients with postoperative wound infection was 2 %, and the incidence of postoperative pain was 8 %. The results didn’t statistically differ between the groups. The recurrence rate was slightly higher in the inpatient group (8.7%). Hematomas and seromas had the same incidence pattern; they were rarely present and without differences between groups. The inguinal hernia repair was associated with low postoperative complications and low recurrence rate. Therefore it is considered that both groups were treated in a safe manner and patient selection was adequate