Hernia最新文献

Objectives: The introduction of ultrasound-guided nerve blocks has led to significant advancements in pediatric postoperative analgesia. In this context, the caudal block (C), a well-established and effective analgesic technique used for many years, has been increasingly complemented by the transversus abdominis plane (TAP) block, which is thought to have fewer side effects and potentially greater efficacy. The aim of our study was to compare these two methods in terms of postoperative analgesic effectiveness.

Materials and methods: This study was conducted as a prospective, randomized, controlled trial. A total of 56 children, aged 1 to 10 years, classified as ASA I and II, undergoing elective inguinal hernia repair, were included. The patients were randomly assigned into two groups. Group T (n = 28) received a TAP block with 0.5 mL/kg of 0.25% bupivacaine under ultrasound guidance, while Group C (n = 28) received a caudal block with the same concentration and volüme of bupivacaine. The primary outcome of the study was the duration of postoperative analgesia, while secondary outcomes included the need for rescue analgesics, complications, and the effects on hemodynamic parameters.

Results: During the postoperative period, adequate analgesia was achieved in both groups for up to the first 4 h. However, after the 6th hour, there was a significant increase in pain scores in the caudal block group. The need for rescue analgesics was lower in the TAP group, although there was no difference in the total amount of analgesics used at 12 h.

Conclusion: Both TAP block and caudal block are effective in providing postoperative analgesia for children undergoing inguinal hernia repair. The TAP block may be preferred due to its longer-lasting postoperative effect and lower need for rescue analgesics.

Introduction: In Germany, the proportion of outpatient surgeries was low during the study period (2014-2019) and low by international standards. Less than 20% of inguinal hernias are treated on an outpatient basis. Hybrid DRGs are intended to promote outpatient treatment, but their impact on the quality of care and referral criteria has not been sufficiently investigated empirically.

Methods: A retrospective analysis of routine data included 90,512 cases from 41 company health insurance funds, spanning 2014 to 2019. These were analysed descriptively in terms of care sector, age, and surgical procedure, as well as through two logistic regressions on reoperations and complications, including interaction effects.

Results: The proportion of outpatient surgeries is already below 40 % in adults and continues to decline with increasing age. The choice of procedure differs significantly between sectors. The regressions explain only 3.3 % and 4 % of the variance, respectively, meaning that the variables have only a minor impact on the success of the surgery. Inpatient surgeries are associated with fewer reoperations and more complications, although the absolute effect size is small. The surgical procedures have a significant influence. There are no relevant interaction effects between the choice of sector and the other variables.

Discussion: A sector-specific allocation based on the analysed parameters cannot be justified based on evidence. Since inpatient procedures do not show consistent superiority, there is no medical advantage over outpatient procedures. A cost-adjusted design of hybrid DRGs appears necessary to enable indication-appropriate procedure selection and to avoid potential misguided incentives that compromise the quality of care.

Background: Hiatal hernia (HH), a common digestive disease, may impact the respiratory system, but systematic evaluation of its effect on cardiopulmonary function and associations with clinical indicators remains insufficient.

Methods: This retrospective study included 248 HH patients (118 surgical [SHH], 130 non-surgical [NHH]) and 516 healthy controls (HC) from The First Affiliated Hospital of Zhejiang University School of Medicine (January 2021-December 2024). Data on basic information, imaging, pulmonary function, echocardiography, and reflux symptoms were collected. Differences in cardiopulmonary function among groups were compared through multi-factor adjustment analysis, and related influencing factors were explored.

Results: HH patients had higher pulmonary infection risk, poorer ventilatory/small airway/diffusing function, and wider pulmonary artery (PA) diameter. NHH patients were older, had larger hernia sacs, and worse cardiopulmonary function but fewer reflux symptoms. The differences in cardiopulmonary function among the above groups weakened after excluding confounding factors such as age. Advanced age and large hernia sac (not reflux) correlated with impaired cardiopulmonary function. 81.2% of SHH patients had improved postoperative respiratory symptoms.

Conclusion: HH is associated with cardiopulmonary dysfunction, manifested by increased risk of pulmonary infection, restrictive ventilatory dysfunction, decreased diffusing capacity, and widened PA diameter. These associations are not significantly associated with reflux and mainly related to age and hernia sac size. This study has limitations due to its retrospective design and can only provide preliminary data reference for exploring the cardiopulmonary function characteristics of HH and their related influencing factors.