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Nivritti G Patil

Publications and source records attributed to Nivritti G Patil.

9 recordsLinked to original sources
PubMed2005

Endoscopic totally extraperitoneal inguinal hernioplasty under spinal anesthesia.

OBJECTIVES: Although endoscopic totally extraperitoneal inguinal hernioplasty (TEP) confers superior early outcomes compared to those of open repair, the requirement of general anesthesia has been held as an argument against the application of TEP by opponents of laparoscopic surgery. To date, the literature on TEP performed under spinal anesthesia remains scarce. The present study reports our early experience performing TEP under spinal anesthesia in selected patients who were medically unfit for general anesthesia. METHODS: Between March 2003 and March 2004, 6 male patients underwent attempted TEP under spinal anesthesia. Selection criteria for the procedure included reducibility of the inguinal hernia and concomitant medical conditions precluding general aesthesia, such as impaired lung function. Informed consent was obtained in all patients. RESULTS: All patients were conscious and able to communicate verbally during the operation. TEP was successfully completed in 4 patients, with a mean operative time of 33 minutes. All 4 patients were asymptomatic and experienced no pain throughout the procedure. Conversion to open repair was required in 2 patients because of uncooperative movement in one, and inadequate neural blockade by spinal anesthesia in the other. Intraoperative cardiorespiratory parameters were stable in all patients. Postoperative urinary retention occurred in 1 patient. The mean length of follow-up exceeded 3 months, and no seroma or recurrence was detected clinically. CONCLUSION: Successful performance of TEP under spinal anesthesia requires the combined efforts of an experienced anesthesiologist, a skilled surgeon, and a cooperative patient. Our initial experience of TEP under spinal anesthesia appeared promising. TEP under spinal anesthesia may have a role in selected patients who are medically unfit for general anesthesia but are otherwise suitable for TEP.

Adult↗
PubMed2005

Multischool, international survey of medical students' attitudes toward "holism".

PURPOSE: Core and optional courses of study in complementary and alternative medicine (CAM) are being incorporated into medical curricula. The authors carried out this study to validate a tool to examine students' attitudes toward holism and CAM and explore the relationships between their attitudes and other demographic and education-related characteristics in a large, multischool, international sample of medical students. METHOD: In 2003 the authors used a modified version of the Integrated Medicine Attitude Questionnaire (IMAQ) to survey students at a total of six medical schools in the United Kingdom, New Zealand, Canada, the United States, and Hong Kong, China. A three-factor model was tested using confirmatory factor analysis, and the internal consistency of the factors were identified using Cronbach's alpha coefficients. A multiple-indicator multiple-cause (MIMIC) analysis was carried out to determine the relationship between IMAQ factors and student characteristics. RESULTS: The authors validated a three-factor model for the IMAQ: (1) attitudes toward holism, (2) attitudes toward the effectiveness of CAM, and (3) attitudes toward introspection and the doctor-patient relationship. Cronbach's alpha coefficients ranged from .41 to .71. The MIMIC model indicated that various background variables were associated with IMAQ factors (gender, race/ethnicity, and school), depending on whether students had previously visited a CAM practitioner and whether students were willing to undertake a special study module in CAM. CONCLUSIONS: Further development work on the IMAQ is required and qualitative research to verify and examine the reasons behind the relationships found in this study between students' attitudes to holism and their demographic and education-related characteristics.

Adolescent↗
PubMed2004

Impact of previous appendectomy on the outcomes of endoscopic totally extraperitoneal inguinal hernioplasty.

Previous lower abdominal surgery presents a technical challenge during endoscopic totally extraperitoneal inguinal hernioplasty. Whether the presence of appendectomy scarring and adhesions will adversely influence the outcomes of totally extraperitoneal inguinal hernioplasty remains largely unknown. The objectives of the present study were to evaluate the safety of totally extraperitoneal inguinal hernioplasty in patients with a history of appendectomy and examine its impact on the perioperative outcomes. Between November 1999 and September 2003, patients who underwent totally extraperitoneal inguinal hernioplasty and had previous appendectomy were recruited as the appendectomy group. For each case patient, 3 age-matched cohorts were randomly selected during the same period. Perioperative data and postoperative outcomes were compared between the 2 groups of patients. A total of 92 patients, 23 cases and 69 controls, were recruited. There was no predominance of either direct or indirect inguinal hernia in the appendectomy group. One patient in the appendectomy group required conversion to transabdominal preperitoneal inguinal hernioplasty because of adhesions. The incidence of peritoneal tear and operative time was higher and longer in the appendectomy group respectively but the differences were not significant. Comparisons of the mean duration of hospitalization, postoperative morbidity rates, pain scores, and time taken to resume normal activities showed no significant difference between the 2 groups. Totally extraperitoneal inguinal hernioplasty in patients who had previous appendectomy was technically safe. A higher incidence of peritoneal tear was anticipated in the presence of appendectomy scarring and adhesions. Postoperative recovery and outcomes were equivalent to those who had no history of appendectomy.

Aged↗
PubMed2003

Surgical competence.

Recent high-profile cases have heightened the need for a formal structure to monitor achievement and maintenance of surgical competence. Logbooks, morbidity and mortality meetings, videos and direct observation of operations using a checklist, motion analysis devices, and virtual reality simulators are effective tools for teaching and evaluating surgical skills. As the operating theater is also a place for training, there must be protocols and guidelines, including mandatory standards for supervision, to ensure that patient care is not compromised. Patients appreciate frank communication and honesty from surgeons regarding their expertise and level of competence. To ensure that surgical competence is maintained and keeps pace with technologic advances, professional registration bodies have been promoting programs for recertification. They evaluate performance in practice, professional standing, and commitment to ongoing education.

Certification↗
PubMed2003

Randomized clinical trial of postoperative subfascial infusion with bupivacaine following ambulatory open mesh repair of inguinal hernia.

BACKGROUND: Wound pain remains the commonest problem after ambulatory open repair of inguinal hernia. Postoperative subfascial infusion of the wound with bupivacaine extends local analgesia at home and may achieve superior analgesia compared with oral analgesics alone. The objective of the present trial was to evaluate the efficacy of postoperative subfascial infusion of the wound with 0.5% bupicavaine at 2 ml per hour for 48 h after operation. METHODS: Forty-four patients who underwent ambulatory open tension-free mesh hernioplasties were randomized to two arms of treatment. The pump group had an infusion pump containing 100 ml 0.5% bupivacaine being placed between the external oblique aponeurosis and the Prolene mesh, whereas the nonpump group was treated with oral analgesics alone. Assuming that an observed difference of 2.0 existed between the mean pain scores of the two groups, the estimated sample size would be at least 20 patients in each group. RESULTS: Postoperative pain scores at rest and on coughing were significantly lower in the pump group than in the nonpump group on days 0 and 1 after surgery (p < 0.01). Before being discharged, none of the pump group patients requested analgesics, but 6 patients of the nonpump group required analgesic supplement (p = 0.025). Ten patients (50%) of the pump group experienced no pain during the period of bupivacaine infusion. Recovery variables, including time taken to resume ambulation and micturition, were comparable between the two groups. The pump and nonpump group patients returned to their normal activities after a median of 3 and 4 days, respectively (p = 0.217). The postoperative morbidity rates of the two groups were similar. CONCLUSION: Postoperative subfascial infusion of the wound with 0.5% bupivacaine achieved superior analgesia compared with oral analgesics alone. Portable infusion pump is a safe technique to continue local analgesia at home after ambulatory open repair of inguinal hernia. The drawbacks of the ON-Q Pain Management System included its high cost and frequent seepage of blood-stained anesthetic fluid into the wound dressing.

Adult↗
PubMed2003

Selective non-stapling of mesh during unilateral endoscopic total extraperitoneal inguinal hernioplasty: a case-control study.

HYPOTHESIS: Selective non-stapling of the mesh during unilateral endoscopic total extraperitoneal inguinal hernioplasty (TEP) may reduce postoperative pain and morbidity rate. DESIGN: Case-control study. SETTING: Division of general surgery at a university-affiliated teaching hospital. PATIENTS: Two hundred patients who underwent TEP. INTERVENTION: Endoscopic total extraperitoneal inguinal hernioplasty with and without stapling the mesh. The mesh was stapled when the diameter of the hernial defect was greater than 4 cm or there was an inadequate overlap of the defect by the mesh. MAIN OUTCOME MEASURES: Postoperative pain score and morbidity rate were compared between patients who had stapling and selective non-stapling of the mesh during TEP. RESULTS: Demographic features, hernia types, and mean operative times of the 2 groups were comparable. Postoperative pain scores upon coughing from the day of operation to postoperative day 6 were lower in patients who had not had the mesh stapled, but the difference was not statistically significant. Comparisons of the mean length of hospital stay, postoperative morbidity, and time taken to resume normal activities showed no significant difference between the 2 groups. With a mean follow-up of 1 year, no neuralgia or recurrence was noted in either group during follow-up. CONCLUSIONS: Selective non-stapling of the mesh did not confer short-term benefits, such as reduced postoperative pain and morbidity, compared with those who had routine stapling of the mesh during TEP. For patients with a hernial defect measuring less than 4 cm, TEP can be performed without stapling the mesh. The selective non-stapling strategy also helps to reduce the cost of the operation and the potential for nerve entrapment.

Case-Control Studies↗
PubMed2003

A comparative outcome analysis of bilateral versus unilateral endoscopic extraperitoneal inguinal hernioplastics.

BACKGROUND: Bilateral inguinal hernia is an accepted indication for endoscopic totally extraperitoneal inguinal hernioplasty (TEP), but few studies have proved that the outcomes of bilateral TEP are as good as those of unilateral TEP. The objective of the present study was to compare the clinical outcomes of patients who underwent unilateral TEP with those of patients who underwent bilateral TEP. PATIENTS AND METHODS: From June 1999 to May 2002, 103 patients underwent simultaneous bilateral TEP. The clinical data and outcomes of these patients were compared with those of an agematched cohort of patients who underwent unilateral TEP during the same period. RESULTS: The demographic features and hernia types were similar for the two groups. The incidence of direct inguinal hernia was significantly higher in the patients with bilateral inguinal hernia. The mean operative time for unilateral TEP was 65 minutes, and for bilateral TEP it was 97 minutes. The mean pain score at rest was significantly lower in the bilateral group than in the unilateral group on postoperative days 2 and 3. Pain scores at rest and during coughing from the day of operation to day 6 were otherwise comparable for the two groups. Comparisons of postoperative morbidity, length of hospital stay, and time to resumption of normal outdoor activities showed no significant differences between the two groups. CONCLUSIONS: The postoperative recovery and morbidity of patients who underwent bilateral TEP were equivalent to those who underwent unilateral TEP. Simultaneous bilateral TEP is safe and advantageous in patients with from bilateral inguinal hernias.

Aged↗
PubMed2002

Prospective randomized trial of pre-emptive analgesics following ambulatory inguinal hernia repair: intravenous ketorolac versus diclofenac suppository.

BACKGROUND: A pre-emptive non-steroidal anti-inflammatory drug is routinely given to patients undergoing ambulatory inguinal hernia repair. The present prospective randomized trial was undertaken to compare the efficacy of intravenous ketorolac and rectal diclofenac for ambulatory inguinal hernia repairs. METHODS: Between June 1999 and February 2001, a total of 108 patients who underwent ambulatory inguinal hernia repairs under general anaesthesia were recruited. Patients were randomized to receive either intravenous ketorolac 30 mg immediately prior to induction of general anaesthesia (n = 54) or rectal diclofenac 50 mg after signing consent at the Day Surgery Centre (n = 54). RESULTS: The demographic features, hernia types, anaesthetic time, dosage of anaesthetic medication and operative details of the two groups were comparable. There was no significant difference in total amount of analgesic consumption and linear analogue pain scores after operation. With regard to recovery variables, the respective times taken to regain ambulation and micturition were similar in both groups. CONCLUSION: Diclofenac suppository 50 mg and intravenous ketorolac 30 mg provided equivalent postoperative analgesia following ambulatory inguinal hernia repair under general anaesthesia. Diclofenac suppository is an economical alternative to intravenous ketorolac. In the interests of cost containment rectal diclofenac could be considered the non-steroidal anti-inflammatory drug of choice for pre-emptive analgesia.

Adolescent↗