Complication Testicular Artery Laceration, Prophylactic Orchiectomy Procedure Umbilical and Right...
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Transcript of Complication Testicular Artery Laceration, Prophylactic Orchiectomy Procedure Umbilical and Right...
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VCUDeath and Complications Conference
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Introduction for Every Case
Complication Testicular Artery Laceration,
Prophylactic Orchiectomy Procedure
Umbilical and Right Inguinal Hernia Repair
Primary Diagnosis Umbilical and Right Inguinal Hernia
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66 yoM referred from his PCP for umbilical and right inguinal hernia which intermittently cause pain
PMH: Peripheral Neuropathy, Chronic LBP, Gout, Anxiety, Hemorrhoids, HTN, Hyperlipidemia, Obesity
PSH: None
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Meds: Vicodin, Amlodipine, Rosuvastatin, Allopurinol, Niacin, Aspirin, Colchicine, Vitamin D, HCTZ, Metoprolol, Docusate
ALL: NSAIDs
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PE: 97.1 53 154/90 BMI: 35.8 ABD- Soft, NTND, reducible umbilical
hernia ~3cm defect Groin- Reducible Right Inguinal Hernia
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Umbilical hernia repaired with PHS
Incision, external oblique fascia was entered, tissue was thick and adherent and there was difficulty identifying the spermatic structures
The vas was identified proximally, but was adherent to a large hernia sac and fatty tissue distally.
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On dissecting around the cord, an arterial bleed was encountered which was thought to be the testicular artery
At this point it was felt the testicle may become ischemic postoperatively and an orchiectomy was performed
The inguinal ligament was sutured to conjoined tendon, closing the inguinal ring completely and overlay mesh was placed
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Analysis of Complication
• Was the complication potentially avoidable?– Yes. Technical Error
• Would avoiding the complication change the outcome for the patient?- Yes. Orchiectomy was unnecessary procedure
• What factors contributed the complication?– Pts obesity, failure identify key structures, technical
error
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Bassini Hernia Repair
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Lichtenstein Hernia Repair
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JAMA 2006
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Fitzgibbons et al
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Fitzgibbons et al
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Fitzgibbons et al
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Fitzgibbons et al
1 Acute Hernia Incarceration occurred in two years in the watchful waiting group (0.3%)
The “Hernia Accident Rate” was 0.0018 events per patient year
By two years 23% of watchful waiting patients had crossed over to surgical repair (31% in 4 years)
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Fitzgibbons et al
Conclusion: Watchful waiting is a safe and
acceptable option for men with assymptomatic or minimally symptomatic hernias
Acute hernia incarcerations occur rarely Patients who develop symptoms have no
greater risk of operative complications than those undergoing prophylactic repair
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JLAST 2012
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Slavin et al
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Slavin et al
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Slavin et al
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Slavin et al
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Slavin et al
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Slavin et al
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Slavin et al
The difference in reoperation rate was in the first two years and appears to affect patients operated on by low caseload laparoscopic surgeons
This study provides evidence of the need for an adequate caseload for surgeons undertaking laparosopic repair of inguinal hernia