Notwendigkeit und Dauer der postoperativen Schonung unter Beachtung der individuellen Belastungssituation durch Beruf und Freizeit von Patienten mit Inguinalhernie nach Lichtenstein-Hernioplastik. Eine prospektive klinische Beobachtungsstudie
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Philipps-Universität Marburg
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Abstract
The present study examined the behaviour of patients who underwent Lichtenstein's hernioplasty in a general-surgical department of a basic and regular care hospital over the period of one year. Out of a total of 165 patients who underwent Lichtenstein's hernioplasty in the Department of General, Visceral and Thoracic Surgery of the UbboEmmius-Klinik Aurich, 112 were initially included in this study. Complete data from 62 patients (55.5%) was collected over the entire period. On average these patients were 64.5 years old (25 to 91y), preoperatively physically resilient, 32 surgeries were performed on an outpatient basis, 30 in the inpatient stay. The ASA status was between I-IV, with the majority being in the ASA II group. 34 patients underwent their first operation on a hernia and 13 patients had already received treatment of another previously occurred hernia gap. The average BMI was 25.5 kg/ m² (20.1 kg/ m² to 35.7 kg/ m²). 80.6% of the patients showed a medium groin hernia gap (size 2 after HERNIAMED classification). Each 9.7% of the patients had smaller gaps (size 1 according to HERNIAMED) and larger gaps (size 3 according to HERNIAMED). Simultaneously the patients` general practitioners were interviewed by means of an anonymous questionnaire about the reasons for their recommendation regarding the duration of postoperative care. The response of the survey was 58.6% (44 of 75 referrers).
Recurrence did not occur after the operation. The rate of postoperative complications, probably due to the small number of patients with early complications, was 14.7%, remaining late complications at 1.07%. In the majority of the cases, the reduction of preoperative pain the patients complained about could be affected positively. This is proven by the reduction of the complained pain to half of the original value on the analogue scale. According to the results of the HERNIAMED examinations, therefore, an average patient collective was examined. In comparison, the results were in the normal range to be expected.
By examining the correlations of the different possible factors influencing the postoperative duration of the respite and thus causing a sick leave or the partial inability to participate in everyday life, it could be shown that 97.1% of the patients follow their general practitioners` recommendations (60 of 62 patients). The patients` personal assessment of their own resilience and thus the duration of postoperative care stepped into the background and was, with few exceptions, left to the doctor. Considering the causes of inguinal hernia formation in combination with the knowledge about the pathophysiology of the surgical method, it can be assumed in the further outlook that a shortening of the recovery time is possible. This would be a significant factor in patient satisfaction, but in view of the number of people in the workforce who underwent operation it also has some economic aspects, as the study indicates that patients could be back to work sooner. For this reason, general practitioners require clear information about the pathophysiological and surgical contexts that merely emphasize the objective conditions, namely the implementation of a consistent pain and wound therapy. The subjective assessment by general practitioners regarding the postoperative duration of treatment should then increasingly make room for a modern follow-up treatment. Under consistent analgesic therapy a shortening to 12 days is reasonable.
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Created: 2018Issued: 2018-06-26Updated: 2018-06-26
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
sick leaveArbeitsunfähigkeitLichtenstein-Hernioplastikinguinal herniaBelastungHernienoperationSchonungKrankschreibungpostoperative restresilienceArbeitsunfähigkeitrecovery timeEntlastungLichtenstein-Hernioplasty
DFG-subjects
HernioplastikInguinalhernieBelastungLichtensteinpostoperativLeistenhernie
DDC-Numbers
610
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Veraart, Cornelis: Notwendigkeit und Dauer der postoperativen Schonung unter Beachtung der individuellen Belastungssituation durch Beruf und Freizeit von Patienten mit Inguinalhernie nach Lichtenstein-Hernioplastik. Eine prospektive klinische Beobachtungsstudie. : Philipps-Universität Marburg 2018-06-26. DOI: https://doi.org/10.17192/z2018.0280.