An audit of the early outcomes of ambulatory inguinal hernia repair at a surgical day-care centre

Ambulatory surgery has been recently gaining popularity owing to the increasing constraints on public-sector health care resources. Inguinal hernia repair is one of the most common day-case operations. This study was conducted to audit the early outcomes of 271 consecutive day-case inguinal hernia repairs performed at the Day Surgery Centre of the Tung Wah Hospital from 1 December 1995 through 31 December 1998. No patients died on the day of their surgery; in 265 (97.8%) cases, patients were discharged home on the day of their operation. Two patients required readmission because of fever and urinary retention, and the postoperative morbidity rate was approximately 5% (14/271 cases). Wound complication was the most common morbidity encountered and pain was the most common discomfort experienced by patients at home. These results suggest that ambulatory hernia repair can be performed safely in a day centre and yields excellent early outcomes.published_or_final_versio

Day case hernia repair: a 3-year audit of patient recruitment

Objective: To audit the recruitment process of patients undergoing day case hernia repair at our Day Surgery Centre and to identify potential areas for further development and expansion of the current clinical service. Design: A retrospective study. Subjects: A total of 1,268 patients underwent hernia repair at our unit from December 1995 to December 1998. Four hundred and eighty-nine patients were initially selected for day case hernia repair but 210 patients were subsequently excluded after pre-anaesthetic assessment. Main outcome measure: Reasons for exclusion from day surgery were classified into patient's preference, social, surgical and medical factors. Results: Growth of day case hernia repair has remained static in the past 3 years. Social grounds (61%) was the most common reason cited for unsuitability for day case hernia repair after pre-anaesthetic assessment. Conclusion: To achieve a full utilization of day case hernia repair service, we recommend modification of day case selection criteria, improvement of patients' acceptance of day surgery by education, promotion of clinicians' awareness of day surgery and a close monitoring of inpatient booking lists. With the escalating health costs in Hong Kong, the development of day case hernia repair represents the future.published_or_final_versio

Percutaneous transhepatic cholangioscopy (PTCS) in management of biliary tract stones: preliminary experience in Tung Wah Hospital

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The efficacy of extracorporeal shock wave lithotripsy in the treatment of ureteric stones

This study was conducted to evaluate the efficacy of in situ extracorporeal shock wave lithotripsy treatment of ureteric stones using the Dornier MFL 5000 lithotripter. From March 1991 to June 1994, 184 patients received in situ extracorporeal shock wave lithotripsy treatment. The overall success rate was 76% (77% for upper; 69% for middle; and 81% for lower ureteric stones, respectively). The level and size of the stones did not affect the final outcome significantly. An average of 1.23 sessions were required for each patient and the rate of major auxiliary intervention was 21%. We conclude that extracorporeal shock wave lithotripsy is an effective treatment for ureteric stones.published_or_final_versio

Ambulatory stapled haemorrhoidectomy: A safe and feasible surgical technique

Objective. To compare outcomes following stapled haemorrhoidectomy as an in-patient versus day-surgery procedure. Design. Prospective non-randomised study. Setting. University affiliated hospitals, Hong Kong. Subjects and methods. Forty-eight consecutive patients who underwent stapled haemorrhoidectomy were included in the study. Twenty-four patients had the procedure in an ambulatory setting and the other 24 were treated as in-patients. The symptoms, operative details, postoperative complications, length of hospital stay, pain scores, analgesic requirements, and patient satisfaction scores were collected. Comparison was made between those patients undergoing ambulatory surgery and those treated as in-patients. Results. There were 25 women and 23 men in the study. The mean age was 46.6 years (standard deviation, 12.1 years). The mean operating time was 29.3 minutes (standard deviation, 9.9 minutes). An incomplete 'doughnut' after stapling was found in one patient. There were no other adverse intra-operative events or complications. Postoperative morbidities occurred in eight patients but none required further surgery. One patient in the day-surgery group could not be discharged because of urinary retention and three required re-admission to hospital because of secondary haemorrhage (n=1) or fever (n=2). There were no differences in the postoperative complications, pain scores, analgesic requirements, and patient satisfaction scores between the two groups. The total mean hospital stay was significantly shorter for those undergoing day-surgery stapled haemorrhoidectomy (0.46 versus 1.9 days, P<0.01). The mean follow-up period was 4.6 months (standard deviation, 4.0 months). All patients reported symptomatic improvement during this time and there was no incidence of faecal incontinence. One patient had a soft stricture, one had a fissure, and two had residual skin tags. All of these problems were conservatively managed, without the need for further surgical procedures. Conclusions. Stapled haemorrhoidectomy is a safe and effective operation for haemorrhoids. It is a feasible procedure to perform as day-surgery. The hospital stay can be significantly shortened, thus reducing the costs associated with in-patient care.published_or_final_versio

Management of ureteric calculi: the pendulum swings

Extracorporeal shock wave lithotripsy (ESWL) for treatment of ureteral calculi has gained wide popularity because of its non-invasive and ambulatory nature. The success rate using the Dornier MFL 5000 is about 77%, but retreatment is often required and stone clearance is gradual. Ureteroscopic lithotripsy (URSL) used to be performed as an in-patient procedure. With the introduction of Holmium laser and establishment of day surgery service, out-patient URSL carries a success rate of 93% and offers immediate stone clearance. It is an attractive alternative for low surgical risk patients as a primary treatment modality.published_or_final_versio

以前瞻性雙盲隨機對照方式, 試驗香港華籍人士在進行經直腸超聲波導引的前列腺活組織切除術時, 使用含利多卡因的凝膠與純粹潤滑劑在止痛效用上的分別

OBJECTIVE. To compare the level of pain experienced by patients during transrectal ultrasound-guided prostatic biopsy using intrarectal 2% lidocaine gel versus plain lubricant gel. DESIGN. Prospective double-blind randomised controlled trial. SETTING. Regional hospital, Hong Kong. PATIENTS. From March 2002 to December 2003, patients who underwent ultrasound-guided prostate biopsy at a Geriatric Urology Centre. MAIN OUTCOME MEASURES. Pain and discomfort scores measured by horizontal visual analogue scales. RESULTS. A total of 338 consecutive patients were randomised to lidocaine gel or plain lubricant gel groups. The two groups were statistically similar in demographic and disease characteristics. There were no significant statistical differences in pain or discomfort score in the lidocaine gel and plain lubricant groups—pain score: 1.75 versus 1.79 (P=0.66) on day 0 and 0.21 versus 0.15 (P=0.97) on day 1; discomfort score: 0.79 versus 0.77 (P=0.86) on day 0 and 0.12 versus 0.12 (P=0.76) on day 1. No major complications were recorded in this cohort. CONCLUSIONS. Transrectal ultrasound-guided trucut biopsy of the prostate can be safely performed with no anaesthesia in Chinese patients. Pain and discomfort are minimal. It was found that 2% lidocaine gel has no statistical therapeutic or analgesic benefit over plain lubricant gel.published_or_final_versio

瑪麗醫院進行腹腔鏡腎臟切除術的早期經驗

OBJECTIVE: To report our early experience of laparoscopic nephrectomy. DESIGN: Prospective data collection. SETTING: Queen Mary Hospital, Hong Kong. PATIENTS: Transperitoneal laparoscopic nephrectomies were performed on 40 patients between July 1997 and December 2002. MAIN OUTCOME MEASURES: Demographic and perioperative data including operating time, blood loss, postoperative pain score, analgesic requirement, complications, time to resume oral intake, ambulatory state, and length of hospital stay. RESULTS: Laparoscopic nephrectomy was performed for 21 solid renal masses, five transitional cell carcinomas, and 14 non-functioning kidneys. Seven (17.5%) patients had previous abdominal surgery. The mean body mass index of the patients was 23.9 kg/m(2) and the mean operating time was 229 minutes. The mean estimated blood loss was 370 mL, and two patients required conversion to open surgery because of intra-operative bleeding. Other complications include diaphragmatic injury, port-site bleeding, chyle leakage, bleeding peptic ulcer, and myocardial ischaemia. The postoperative mean analgesic requirement was 26 mg of morphine sulphate equivalent. The mean time for patients to resume oral diet and full ambulation was 1.3 and 2.8 days, respectively, and the mean length of hospital stay was 6.7 days. The mean diameter of the solid renal tumour was 4.1 cm and the surgical margins of all resected specimen for malignant tumours were negative. CONCLUSION: Laparoscopic nephrectomy is a safe and efficacious approach for resection of benign non-functioning kidneys and malignant renal tumours.published_or_final_versio

Association between pain and sexual health in older people: results from the English Longitudinal Study of Ageing

There is little information on the impact of pain on sexual health in later life. The aim of this analysis was to determine the association between self-reported pain and sexual health in older men and women. Data were collected for the nationally representative English Longitudinal Study of Ageing. Community-dwelling adults aged 50 years and older completed the Sexual Relationships and Activities questionnaire in wave 6 (2012/2013). Participants were asked (waves 1 to 6 [2002- 2013]) if they were "often troubled with pain" and, how severe was their pain; mild, moderate or severe. The association between pain and sexual health was assessed using logistic regression. Analyses were stratified by gender, with adjustments made for age followed by adjustments for health and lifestyle factors, depressive symptoms and socioeconomic status. Of the 3,916 participants who reported having sexual activity in the past year, 28% of women and 23% of men reported experiencing moderate or severe pain often at wave 6. After adjusting for age, compared to men experiencing no pain, men with moderate or severe pain reported less frequent intercourse and masturbation, more erectile difficulties, and more concerns about their sexual health. After age adjustment there were no associations between pain severity and sexual health among women. Of the 1,872 participants with a cumulative pain score, there were significant associations between reporting pain and concerns about sexual health in both men and women. Pain was associated with impairment in sexual health in men and women though the effect was more marked in men

Changes in prevalence of obesity and high waist circumference over four years across European regions: the European male ageing study (EMAS).

Diversity in lifestyles and socioeconomic status among European populations, and recent socio-political and economic changes in transitional countries, may affect changes in adiposity. We aimed to determine whether change in the prevalence of obesity varies between the socio-politically transitional North-East European (Łódź, Poland; Szeged, Hungary; Tartu, Estonia), and the non-transitional Mediterranean (Santiago de Compostela, Spain; Florence, Italy) and North-West European (Leuven, Belgium; Malmö, Sweden; Manchester, UK) cities. This prospective observational cohort survey was performed between 2003 and 2005 at baseline and followed up between 2008 and 2010 of 3369 community-dwelling men aged 40-79 years. Main outcome measures in the present paper included waist circumference, body mass index and mid-upper arm muscle area. Baseline prevalence of waist circumference ≥ 102 cm and body mass index ≥ 30 kg/m2, respectively, were 39.0, 29.5 % in North-East European cities, 32.4, 21.9 % in Mediterranean cities, and 30.0, 20.1 % in North-West European cities. After median 4.3 years, men living in cities from transitional countries had mean gains in waist circumference (1.1 cm) and body mass index (0.2 kg/m2), which were greater than men in cities from non-transitional countries (P = 0.005). North-East European cities had greater gains in waist circumference (1.5 cm) than in Mediterranean cities (P < 0.001). Over 4.3 years, the prevalence of waist circumference ≥ 102 cm had increased by 13.1 % in North-East European cities, 5.8 % in the Mediterranean cities, 10.0 % in North-West European cities. Odds ratios (95 % confidence intervals), adjusted for lifestyle factors, for developing waist circumference ≥ 102 cm, compared with men from Mediterranean cities, were 2.3 (1.5-3.5) in North-East European cities and 1.6 (1.1-2.4) in North-West European cities, and 1.6 (1.2-2.1) in men living in cities from transitional, compared with cities from non-transitional countries. These regional differences in increased prevalence of waist circumference ≥ 102 cm were more pronounced in men aged 60-79 years than in those aged 40-59 years. Overall there was an increase in the prevalence of obesity (body mass index  ≥ 30 kg/m2) over 4.3 years (between 5.3 and 6.1 %) with no significant regional differences at any age. Mid-upper arm muscle area declined during follow-up with the greatest decline among men from North-East European cities. In conclusion, increasing waist circumference is dissociated from change in body mass index and most rapid among men living in cities from transitional North-East European countries, presumably driven by economic and socio-political changes. Information on women would also be of value and it would be of interest to relate the changes in adiposity to dietary and other behavioural habits