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首页> 外文期刊>Surgical Endoscopy >Day case laparoscopic herniorraphy. A NICE procedure with a long learning curve.
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Day case laparoscopic herniorraphy. A NICE procedure with a long learning curve.

机译：日例腹腔镜疝气。具有较长学习曲线的NICE程序。

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BACKGROUND: The aim of this study was to evaluate day case laparoscopic herniorraphy (LH) and to ascertain the impact of trainee surgeons on its performance. METHODS: We performed a prospective study of ambulatory laparoscopic transabdominal preperitoneal herniorraphies performed in a dedicated day surgical unit between March 1996 and October 2003. RESULTS: A total of 840 herniorraphies were performed in 706 consecutive patients. Surgery was performed by 15 higher surgical trainees and three consultant surgeons. The mean operating times for trainees were longer for unilateral (48.4 +/- 0.98 vs 41.4 +/- 0.87 min, p < 0.05) and bilateral (69.0 +/- 3.24 vs 53.0 +/- 1.68 min, p < 0.05) repairs than for consultants. Subgroup analysis demonstrated that after an experience of 40 procedures, trainee times approached those of the consultants (41.39 +/- 1.17 vs 41.4 +/- 0.87 min, p= 0.31). LH repair was well tolerated and associated with minimal postoperative pain and nausea. Mean pain scores postoperatively andat 24 h were 2.69 +/- 0.11 and 2.07 +/- 0.09, respectively. Mean nausea scores postoperatively and at 24 h were 0.34 +/- 0.06 and 0.22 +/- 0.06, respectively. Ninety-three percent of patients (n = 657) were discharged within 8 h. There were two conversions to an open procedure (0.1%) and two significant complications (0.1%). Ninety-five percent of patients who responded to our questionnaire (n = 398/419) were satisfied with surgery and would undergo day case laparoscopic herniorraphy again. CONCLUSIONS: Laparoscopic herniorraphy is a safe technique suitable for day case surgery. Operator experience dictates duration of surgery. Trainees' operating times approach those of consultants after 40 procedures. Prolonged operating times and increased cost are not justifiable reasons for not recommending LH.
机译：背景：这项研究的目的是评估日例腹腔镜疝气（LH），并确定实习医生对其性能的影响。方法：我们对1996年3月至2003年10月在专门的一天手术室中进行的非卧床腹腔镜经腹腹膜前疝治疗进行了前瞻性研究。结果：706例连续患者共进行了840例疝气治疗。手术由15位高级外科手术学员和3位顾问外科医生进行。单侧（48.4 +/- 0.98 vs 41.4 +/- 0.87 min，p <0.05）和双侧（69.0 +/- 3.24 vs 53.0 +/- 1.68 min，p <0.05）培训学员的平均手术时间更长对于顾问。亚组分析表明，经过40道程序的培训，学员的培训时间接近了顾问的培训时间（41.39 +/- 1.17分钟vs 41.4 +/- 0.87分钟，p = 0.31）。 LH修复耐受性良好，并且术后疼痛和恶心最小。术后和24小时的平均疼痛评分分别为2.69 +/- 0.11和2.07 +/- 0.09。术后和24小时时的平均恶心评分分别为0.34 +/- 0.06和0.22 +/- 0.06。 93％的患者（n = 657）在8小时内出院。有两次转换为开放手术（0.1％）和两个重大并发症（0.1％）。对我们的调查表作出回应的患者（n = 398/419）中有百分之九十五对手术感到满意，并将再次接受日间腹腔镜疝气检查。结论：腹腔镜疝气检查是一种适合日间手术的安全技术。操作员的经验决定了手术的持续时间。经过40道程序，学员的工作时间接近顾问的工作时间。延长运行时间和增加成本并不是不推荐LH的正当理由。

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