Skip to main content

Logistics and Specialised Hernia Units

  • Chapter
  • First Online:
Book cover Management of Abdominal Hernias

Abstract

A Specialised Hernia Unit is a multidisciplinary programme providing state-of-the-art care for all types of hernias, from the most common to the most complex and technically challenging, from the simple primary hernia to multi-recurrent hernia or mesh-related complication (such as infection or post-operative chronic pain), from the small ventral hernia to the swiss cheese with real loss of substance incisional hernia, from the pubic inguinal pain syndrome (the so-called sportsman hernia) to the floppy abdomen postpartum.

General surgeon, plastic and reconstructive surgeon, osteopath and physiotherapist, nutritionist, radiologist, anaesthesiologists and pain therapist: these are essential part of the unit and collaborate to gain better result in each single patient.

Surgeon should be confident in all kinds of approach (open and laparoscopic, both for inguinal and ventral hernia, in anterior and posterior approach), in the use of further surgical step in abdominal wall reconstruction, like, for example, in the different possibilities of component separation or TAR (transversus abdominis release) when necessary and in the use of all surgical implants (synthetic, composite or biological) and their fixation.

Several procedures in abdominal wall hernia repair can be performed as outpatient.

In ambulatory surgery (called also as day surgery or outpatient service), as the name implies, the patient is sent home the same day of the surgical treatment, with no overnight stay.

EHS guidelines for inguinal hernia repair report day surgery as safe, effective and in addition cheaper for every patient.

Modern day surgery is not simply a shortened hospital stay or an architectural model. Rather, it is a complex, multifaceted concept involving institutional, organisational, medical, economic and qualitative consideration.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet. 2003;362(9395):1561–71.

    Article  Google Scholar 

  2. Jacob D, Hackl J, Bittner R, Kraft B, Köckerling F. Perioperative outcome of unilateral versus bilateral inguinal hernia repairs in TAPP technique: analysis of 15,176 cases from the herniamed registry. Surg Endosc. 2015;29:3733–40.

    Article  CAS  Google Scholar 

  3. Gilbert AI, Graham MF, Young J, Patel BG, Shaw K. Closer to an ideal solution for inguinal hernia repair: comparison between general surgeons and hernia specialists. Hernia. 2006;10:162–8.

    Article  CAS  Google Scholar 

  4. Köckerling F, Berger D, Jost JO. What is a certified hernia center? The example of the German Hernia Society and German Society of General and Visceral Surgery. Front Surg. 2014;1:26.

    PubMed  PubMed Central  Google Scholar 

  5. Opening Statement of founding members of the International Association for Ambulatory Surgery. (IAAS) in 1995.

    Google Scholar 

  6. Celli G, Campanelli G, Corbellini L, de Stefano B, Fortino A, Francucci M, Mastrobuono I, Torre M. Modelli organizzativi e sedi di svolgimento. Commisssione di studio sulla day-surgery e la chirurgica ambulatoriale istituita con decreto Ministeriale del 12 settembre 2000 Ministero della Sanità and 2001 pp. 21–23. Proposta per l’organizzazione, lo sviluppo e la regolamentazione della attività chirurgiche a ciclo diurno.

    Google Scholar 

  7. NHS Modernisation Agency. The 10 high impact changes for service improvement and delivery. London: Department of Health Puplications; 2004.

    Google Scholar 

  8. Davis JE. The major ambulatory surgical center and how it is developed. Surg Clin North Am. 1987;67:671–92.

    Article  CAS  Google Scholar 

  9. Baxter B. Day case surgery. Clarke P, Jones J, editors. Brigden’s operating department practice. Edinburgh. Churchill Livingstone; 1998. pp. 24–31.

    Google Scholar 

  10. Cole BOI, Hislop WS. A grading system in day surgery: effective utilisation of theatre time. J R Coll Surg Edinb. 1998;43:87–8.

    CAS  PubMed  Google Scholar 

  11. Sorabjee JS. Day care surgery—the physicians viewpoint. Bombay Hosp J. 2003;45:2.

    Google Scholar 

  12. Handerson J, Goldacre MJ, Griffith M, et al. Day case surgery: geographical variation, trends and readmission rates. J Epidemiol Community Health. 1989;43:302–5.

    Google Scholar 

  13. Cahill CJ, Tillin T, Jarrtt PEM. Wide variations in day case practice and outcomes in Southern England—a comparative audit in 15 hospitals. Abstracts of the 1st International Congress on ambulatory surgery. Brusseil, Belgium; 1995.

    Google Scholar 

  14. Lewis C, Bryson J. Does day case surgery generate extra workload for primary and community health service staff? Ann R Coll Surg Engl. 1998;80:200.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Australian Day Surgery Council. Day surgery in Australia. Revised edition. Melbourne: Royal Australasian College of Surgeons; 2004. First published; 1981.

    Google Scholar 

  16. Commission Authorities. Measuring quality: the patients view of day surgery. London: HMSO; 1991.

    Google Scholar 

  17. Department of Health. Day surgery: operational guide. Waiting, booking and choice. London: Department of Health Publications; 2002.

    Google Scholar 

  18. Jarrett PEM, Staniszewski A. The development of ambulatory surgery and future challenges. In: Lemos P, Jarrett P, Philip B, editors. Day surgery: development and practice. London: First International Edition; 2006. p. 24–6.

    Google Scholar 

  19. Farquharson EL. Early ambulation with special reference to herniorrhaphy as an outpatient procedure. Lancet. 1955;269:517–9.

    Article  CAS  Google Scholar 

  20. Goulbourne IA, Ruckley CV. Operations for hernia and varicose veins in a day-bed unit. Br Med J. 1979;2:712–4.

    Article  CAS  Google Scholar 

  21. Michelsen M, Walter F. Comparison of outpatient and inpatient operations for inguinal hernia (1971 to 1978). Zentralbl Chir. 1982;107:94–102.

    CAS  PubMed  Google Scholar 

  22. Dhumale R, Tisdale J, Banwell N. Over a thousand ambulatory hernia repairs in a primary care setting. Ann R Coll Surg Engl. 2010;92:127–30.

    Article  CAS  Google Scholar 

  23. Acevedo A, León J. Ambulatory hernia surgery under local anesthesia is feasible and safe in obese patients. Hernia. 2010;14(1):57–62.

    Article  CAS  Google Scholar 

  24. Kurzer M, Kark A, Hussain ST. Day-case inguinal hernia repair in the elderly: a surgical priority. Hernia. 2009;13(2):131–6.

    Article  CAS  Google Scholar 

  25. Pineault R, Contandriopoulos AP, Valois M, Bastian ML, Lance JM. Randomized clinical trial of one-day surgery. Patient satisfaction, clinical outcomes, and costs. Med Care. 1985;23(2):171–82.

    Article  CAS  Google Scholar 

  26. Prescott RJ, Cutherbertson C, Fenwick N, Garraway WM, Ruckley CV. Economic aspect of day care after operations for hernia or varicose vein. J Epidemiol Community Health. 1978;32:222–5.

    Article  CAS  Google Scholar 

  27. Ruckley CV, Cuthbertson C, Fenwick N, Prescott RJ, Garraway WM. Day care after operations for hernia or varicose veins: a controlled trial. Br J Surg. 1978;65:456–9.

    Article  CAS  Google Scholar 

  28. Ramyl VM, Ognonna BC, Iya D. Patient acceptance of outpatient treatment for inguinal hernia in Jos Nigeria. Cent Afr J Med. 1999;45:244–6.

    Google Scholar 

  29. Ramyil VM, Iya D, Ogbonna BC, Dakum NK. Safety of daycare hernia repair in Jos Nigeria. East Afr Med J. 2000;77(6):326–8.

    CAS  PubMed  Google Scholar 

  30. Mattila K, Vironen J, Eklund A, Kontinen VK, Hynynen M. Randomized clinical trial comparing ambulatory and inpatient care after inguinal hernia repair in patients aged 65 years or older. Am J Surg. 2011;201(2):179–85.

    Article  Google Scholar 

  31. Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, Fortelny R, Heikkinen T, Jorgensen LN, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski S, Weber G, Simons MP. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014;18:151–63.

    Article  CAS  Google Scholar 

  32. Mitchell JB, Harrow B. Costs and outcomes of inpatient versus outpatient hernia repair. Health Policy. 1994;28:143–52.

    Article  CAS  Google Scholar 

  33. Weyhe D, Winnemoller C, Hellwig A, Meurer K, Plugge H, Kasoly K, Laubenthal H, Bauer KH, Uhl W. (Section sign) 115 b SGB V threans outpatient treatment for inguinal hernia. Analysis of outcome and economics. Chirurg. 2006;77:844–55.

    Article  CAS  Google Scholar 

  34. Engbaek J, Bartholdy J, Hjortsø NC. Return hospital visits and morbidity within 60 days after day surgery: a retrospective study of 18736 day surgical procedures. Acta Anaesthesiol Scand. 2006;50:911–9.

    Article  CAS  Google Scholar 

  35. Jarrett PE. Day care surgery. Eur J Anaesthesiol Suppl. 2001;23:32–5.

    Article  CAS  Google Scholar 

  36. De Lathouwer C, Poullier JP. How much ambulatory surgery in the World in 1996–1997 and trends? Ambul Surg. 2000;8:191–210.

    Article  Google Scholar 

  37. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13:343–403.

    Article  CAS  Google Scholar 

  38. Databank of Ministero della Salute, http://www.sanita.it. Healthcare Department of Italy.

  39. Moreno-Egea A, Cartagena J, Vicente JP, Carrillo A, Aguayo JL. Laparoscopic incisional hernia repair as a day surgery procedure: audit of 127 consecutive cases in a university hospital. Surg Laparosc Endosc Percutan Tech. 2008;18(3):267–71.

    Article  Google Scholar 

  40. Donati M, Gandolfo L, Privitera A, Brancato G, Donati A. Day hospital for incisional hernia repair: selection criteria. Acta Chir Belg. 2008;108(2):198–202.

    Article  CAS  Google Scholar 

  41. Engledow AH, Sengupta N, Akhras F, Tutton M, Warren SJ. Day case laparoscopic incisional hernia repair is feasible, acceptable and cost effective. Surg Endosc. 2007;21(1):84–6.

    Article  CAS  Google Scholar 

  42. De Jong D, Rinkel RNPM, Marin J, van Kesteren PJM, Rangel R, Imhof S, Henry Y, Baart JA, de Gast A, Ekkelkamp S, van der Horst CMAM, de la Rosette JJMCH, Laguna Pes MP. Day surgery procedures. In: Lemos P, Jarrett P, Philip B, editors. Day surgery development and practice. London: First International Edition; 2006. p. 91–2.

    Google Scholar 

  43. Marshall S, Chung F. Discharge criteria and postdischarge complications. Anesth Analg. 1999;88:508e17.

    Article  Google Scholar 

Download references

Acknowledgement

This is an updated version of the chapter authored by Giampiero Campanelli, Marta Cavalli, Valentina Bertocchi and Cristina Sfeclan. Valentina Bertocchi and Cristina Sfeclan have not participated in the revision of this chapter for the 5th edition.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giampiero Campanelli .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Campanelli, G., Bruni, P.G., Lombardo, F., Morlacchi, A., Cavalli, M. (2018). Logistics and Specialised Hernia Units. In: LeBlanc, K., Kingsnorth, A., Sanders, D. (eds) Management of Abdominal Hernias. Springer, Cham. https://doi.org/10.1007/978-3-319-63251-3_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-63251-3_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-63250-6

  • Online ISBN: 978-3-319-63251-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics