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      Short-Term Complications of Hemorrhoidectomy in Outpatient and Inpatient Operations in Shiraz, Southern Iran

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          Abstract

          Background

          Today, hospitals and patients are both willing to benefit from outpatient services. Considering limits of supply, it seems that there is a need to run productive management in offering health services to prevent wasting of supplies and facilities. This study compares the complications caused by hemorrhoidectomy in outpatient and inpatient operations.

          Methods

          In a cross-sectional study during 1.5 years, 208 patients without any background disease were enrolled. They were randomly allocated into two groups (inpatient and outpatient) and interviewed within two weeks after surgical operations. The data were collected through a questionnaire and physical examination. The complications in the two groups of operating theater of hospital and clinic were then compared regarding sex, occupation, education and etc.

          Results

          One week after the surgical operation, the patients in the hospital operating theater showed significantly a better healing recovery of their wound. Other complications such as pain, hemorrhage, infection, inflammation, involuntary emission of feces and gas indicated no significant difference between the two groups. After 2 weeks, more pain was noticed in patients in the operating theaters of the hospital and in clinics, there was more infection visible. The hemorrhage, inflammation, wound healing, involuntary emission of feces and gas did not indicate a significant difference between the operating theater of hospital and the clinic. There was no significant difference regarding the patients' satisfaction in the two groups.

          Conclusion

          We recommend that for optimized use of supplies and equipments in operating theaters and to lower the cost and shorten queue of patients, grade 2 hemorrhoids are performed in the operating theater of clinics considering sterilization and safety procedures.

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          Most cited references21

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          Persistent pain and faecal urgency after stapled haemorrhoidectomy.

          Haemorrhoidectomy usually cures haemorrhoids. Day surgery is feasible, and is associated with high patients' satisfaction and few complications, but patients take an average of 2 weeks off work after surgery. Stapled haemorrhoidectomy has the potential to decrease postoperative pain and time off work. However, data on long-term efficacy and function are lacking. 22 patients underwent stapled haemorrhoidectomy: seven in a pilot study, and 15 in a randomised controlled trial to compare the new stapled operation with diathermy haemorrhoidectomy in a day-case setting. All operations were done by one consultant surgeon. 16 patients were followed up for longer than 6 months, five of whom (31% [95% CI 8.5-54.0%]) developed symptoms of pain and faecal urgency which persisted for up to 15 months postoperatively. The randomised trial was suspended, and patients were investigated with endoanal ultrasonography, anorectal physiology, and examination under anaesthetic. All five affected patients were reviewed by two independent surgeons experienced in the stapled operation. In one patient, a fibroepithelial polyp was found adjacent to an anodermal ulcer; in the other patients, no abnormality was found. Four of the five affected patients had some muscle incorporated into the doughnut, compared with only one of 11 of the unaffected patients (p=0.012, Fisher's exact test). No other significant differences in operative variables were identified between patients with and without symptoms. Persistent severe pain and faecal urgency has been found in a disturbingly high proportion of patients after stapled haemorrhoidectomy. The mechanism behind this phenomenon is unclear, although muscle incorporation in the doughnut may have a role. Other groups who have studied stapled haemorrhoidectomy urgently need to audit their long-term results to assess the frequency of this problem.
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            The learning curve for totally extraperitoneal laparoscopic inguinal hernia repair.

            Several laparoscopic techniques have been introduced to re pair inguinal hernia, the newest and most promising being a totally extraperitoneal approach. Nevertheless, the surgeon may encounter several complications and technical difficulties associated with the transition from the conventional anterior operation. In late 1993 and 1994, 120 patients were operated on for inguinal hernia using the totally extraperitoneal approach by four laparoscopic surgeons inexperienced in this new technique in a secondary referral setting. Their learning curve was assessed through operation time, perioperative and postoperative complications, and technical difficulties. Median operative time decreased significantly (P = 0.0003) when going through the learning curve. During the initial part of the learning curve, conversion to another technique was necessary in 10 (8%) cases, and in 6 of these cases, conversion was needed for a peritoneal tear (relative risk for conversion if peritoneal tear was present: 4.0; 95% confidence interval 1.2 to 13.1, P = 0.025). The median operative time for Nyhus type IIIb and IVb hernias was significantly longer than for other types (70 versus 55 minutes, P = 0.003). Median postoperative stay was 2 days (range 0 to 7). There were 10 recurrences within 6 months due to technical or judgement errors. For surgeons, the learning curve for totally extraperitoneal laparoscopic hernia repair can be overcome; however, the presence of an experienced surgeon during the procedure is vital, as this may prevent unnecessary recurrences.
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              Patient satisfaction with inpatient versus outpatient reconstruction of the anterior cruciate ligament: a randomized clinical trial.

              To compare satisfaction levels after reconstruction of the anterior cruciate ligament (ACL) between inpatients and outpatients by means of a valid and comprehensive outcome tool. Fifty patients examined at a tertiary clinic who met the study's inclusion criteria (15-50 yr old, no previous ACL reconstruction, > 6 h after injury, living < 1 h from hospital, assigned a caregiver for outpatient management within 48 h of injury, no serious health condition, no known hypersensitivity to ASA/NSAIDs, bleeding disorder or gastric ulcer, ability to cope at home after operation) were recruited and randomized into either the inpatient or outpatient groups. Inpatients stayed overnight in hospital after their ACL reconstruction and were discharged home the next day. Outpatients were discharged home on the day of the procedure. All patients attended a preoperative educational session and were required to meet the same discharge criteria (able to bear weight using crutches and to void, to be reasonably pain free, no nausea or vomiting, no excess bleeding or drainage, be alert, be given take-home medications and be in the company of a caregiver). Standardized anesthetic and postoperative analgesic protocols were used. One week after ACL reconstruction, patient satisfaction was quantified with a previously validated visual analogue questionnaire (maximum score of 100). We collected data on 21 inpatients and 19 outpatients. The mean overall-satisfaction score of the outpatient group was higher than that of the inpatient group (85.1 v. 78.2, p = 0.015). Between-group differences in postoperative pain, nausea, rate of readmission and complications were not significant. As determined by a comprehensive, population-specific, validated outcome, patient satisfaction is higher when ACL reconstruction is done on an outpatient basis.
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                Author and article information

                Journal
                Iran Red Crescent Med J
                Iran Red Crescent Med J
                Kowsar
                Iranian Red Crescent Medical Journal
                Kowsar
                2074-1804
                2074-1812
                April 2011
                01 April 2011
                : 13
                : 4
                : 267-271
                Affiliations
                [1 ]School of Management and Information Science, Shiraz University of Medical Sciences, Shiraz, Iran
                [2 ]Laparascopy Research Center,Shiraz University of Medical Sciences, Shiraz, Iran
                [3 ]Stem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
                [4 ]Health Service Management, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
                Author notes
                [* ]Correspondence: Seyed Vahid Hosseini, MD, Professor of Laparascopy Research Center, And Stem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Tel.: +98-711-2340779, Fax: +98-711-2340039, E-mail: keshtkaa@ 123456sums.ac.ir
                Article
                3371953
                22737477
                330d6b5f-42de-4d6f-a8d7-a231d3bbce39
                Copyright © 2011, Kowsar M.P. Co.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 June 2010
                : 18 October 2010
                : 11 October 2010
                Categories
                Short Communication

                Medicine
                inpatient,complications,hospitalization,outpatient,hemorrhoidectomy
                Medicine
                inpatient, complications, hospitalization, outpatient, hemorrhoidectomy

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