Introduction Totally extra-peritoneal (TEP) inguinal hernia repair allows identification and repair of incidental non-inguinal groin hernias. We assessed the prevalence of incidental hernias during TEP inguinal hernia repair and identified the risk factors for incidental hernias. Materials and Methods Consecutive patients undergoing TEP repair from May 2005 to November 2012 were the study cohort. Inspection for ipsilateral femoral, obturator and rarer varieties of hernia was undertaken during TEP repair. Patient characteristics and operative findings were recorded on a prospectively collected database. Results A total of 1,532 TEP repairs were undertaken in 1,196 patients. Ninety-three patients were excluded due to incomplete data, leaving 1,103 patients and 1,404 hernias for analyses (1,380 male; 802 unilateral and 301 bilateral repairs; median age, 59 years). Among the 37 incidental hernias identified (2.6% of cases), the most common type of incidental hernia was femoral (n=32, 2.3%) followed by obturator (n=2, 0.1%). Increasing age was associated with an increased risk of incidental hernia, with a significant linear trend (p<0.01). The risk for patients >60 years of age was 4.0% vs 1.4% for those aged <60 years (p<0.01). Incidental hernias were found in 29.2% of females vs 2.2% of males, (p<0.0001). Risk of incidental hernia in those with a recurrent inguinal hernia was 3.0% vs 2.6% for primary repair (p=0.79). Conclusions Incidental hernias during TEP inguinal hernia repair were found in 2.6% of cases and, though infrequent, could cause complications if left untreated. The risk of incidental hernia increased with age and was significantly higher in patients aged >60 years and in females.
Introduction: Current National Institute for Health and Care Excellence (NICE) guidelines recommend the use of Low Molecular Weight Heparin (LMWH) for one month post-operatively in abdominal and pelvic cancer surgery to reduce risk of venous thromboembolism. We audited the prescription of LMWH at discharge and the compliance of patients with LMWH post-operatively and instigated measures to improve compliance. Materials and Methods: All patients undergoing major urological surgery from November 2011 to April 2012 were audited, with data collected on evidence of post-operative prescription (from discharge summaries). Patients within this 3-month period were questioned regarding compliance following discharge. Following this, changes were instigated to improve compliance (earlier discussion of post-operative LMWH administration in clinic, improved patient and junior doctor education). All patients undergoing surgery from November 2012 to June 2013 were identified and a re-audit completed. Results: Post-operative prescription of LMWH improved overall from 73% to 88%. Patient compliance to complete LMWH course improved from 23% to 88%. At re-audit, 97% of patients felt that training was adequate, and 94% of patients understood the rationale for taking LMWH at re-audit. Conclusion: Education of junior doctors improved prescription of LMWH at discharge. Improved patient education improves community LMWH use compliance post-discharge.
Results The blood results of 440 patients were reviewed using the ICE (Integrated Clinical System). The median age was 67-years. Of the 440 patients, 310 had deranged LFTs, 86 had a normal liver profile, and 44 had no LFTs taken prior to ERCP. Of those with deranged LFTs, 2% had only a raised bilirubin, less than 6% had either only raised transaminases or both raised transaminases and bilirubin, 12% had only both raised alkaline phosphatase (ALP) and bilirubin, 15% had both raised ALP and transaminases, 22% had only raised ALP, and 43% had a trio of raised bilirubin, ALP, and transaminases. Only 11 patients had no coagulation profile taken before the procedure. Out of the remaining 429 patients, 15 were on warfarin, 2 had haemophilia, 1 was thrombocytopenic, and 1 had von Willebrand's disease. However, out of 440 patients only 2 had an INR greater than 1.5, 1 of them being on warfarin. Conclusion These results suggest that routine measurement of coagulation profile is unnecessary. This would reduce time delays, decrease costs and avoid further tests in patients. We suggest that the current pre-ERCP investigation guidelines be reviewed.
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