mykytiuk s_from reg to nat (poland, 2012)

7/31/2019 Mykytiuk S_From Reg to Nat (Poland, 2012)

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FROM REGIONAL TO NATIONAL

HERNIA REGISTER IN UKRAINE

Mykytiuk S., Mykytiuk O.&

Scientific Surgical Society of Khmelnytskyi Region(Khmelnytskyi, Ukraine)


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Ukraine is a second largest country on theEuropean continent, after Russia.

UKRAINE


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Khmelnytskyi Regionin the west of Ukraine

is one of the 25 provinceswith the administrative center

in Khmelnytskyi City, named byhetman Bohdan Khmelnytsky.

Kamianets-Podilskyi Castle above the Smotrych River and its

surrounding complex is one of the Seven Wonders of Ukraine.

KHMELNYTSKYI REGION


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POPULATION OF UKRAINE

According to the State Statistics Committee of Ukraine,the population of Ukraine in 2012 has totaled 45.63 million ,the population of Khmelnytsky Region is about 1.32 million(2.9%) and is continually decreasing.

, 19982012


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DEMOGRAPHIC SITUATION

The demographicsituation in Ukrainehas been such for lastyears, that the life

expectancy for men isonly 65,2 years andfor women 75,5years.


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SURGERY IN UKRAINE

The total number of operations performed every yearin Ukraine remains almost unchanged and is close to2.5 million. But in Khmelnitsky region it averages67.3 thousand per year (2.75%).


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SURGERY INDEXES

Index UkraineKhmelnytskyi

Region %Population, mln 45,63 1,32 2,9Total number of operations 2469168 67325 2,8


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SURGERY IN UKRAINE

The total number of operations performed every yearin Ukraine remains almost unchanged and is close to2.5 million. But in Khmelnitsky region it averages65.5 thousand per year (2.75%).

Every year around 340.000 operations on abdominalorgans are performed in Ukraine, and in KhmelnitskyRegion rather more 10.000 (2.9%).


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SURGERY INDEXES


Region %Population, mln 45,63 1,32 2,9Total number of operations 2469168 67325 2,7Operations on abdominal organs 338557 10205 2,9


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HERNIA SURGERY IN UKRAINE

The total number of operations performed every yearin Ukraine is more than 92.000. But in Khmelnitskyregion it averages around 3300 per year (3.6%).


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SURGERY INDEXES


Region %Population, mln 45,63 1,32 2,9Total number of operations 2469168 67325 2,7Operations on abdominal organs 338557 10205 2,9Operations on hernia 92297 3338 3,6


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EMERG. SURGERY IN UKRAINE

Despite the gradual population decreasing andthe slight reduction in the number of operationsof acute surgical pathology in Ukraine and Region,the decreasing of incarcerated hernia frequencyis not observed for the last decade.

On average, every year 12.7 thousand of incarceratedhernia cases are operated in Ukraine and 256 of it(2.0%) in Khmelnytsky Region.


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SURGERY INDEXES


Region %Population, mln 45,63 1,32 2,9Total number of operations 2469168 67325 2,7Operations on abdominal organs 338557 10205 2,9Operations on hernia 92297 3338 3,6Total number of urgent operations 184671 4403 2,4Operations on complicated hernia 12719 256 2,0


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ELECT. SURGERY IN UKRAINE

The number of nonincarcerated hernia operationsremains within 80.000 in Ukraine, and in 2011 it hasincreased to 3101 within the region (3,8%).

0

500

1000

1500

2000

2500

3000

3500

2001 2003 2005 2007 2009 2011

comlicated uncomplicated


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SURGERY INDEXES


Region %Population, mln 45,63 1,32 2,9Total number of operations 2469168 67325 2,7Operations on abdominal organs 338557 10205 2,9Operations on hernia 92297 3338 3,6Total number of urgent operations 184671 4403 2,4Operations on complicated hernia 12719 256 2,0Operations on uncomplicated hernia 79578 3101 3,8


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LATE HOSPITALIZ. IN UKRAINE

The quantity of cases of the late hospitalizations(> 24 h.) in Ukraine is almost identical with itsquantity in Khmelnytsky Region and it averages 21% .


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SURGERY INDEXES


Region %Population, mln 45,63 1,32 2,9Total number of operations 2469168 67325 2,7Operations on abdominal organs 338557 10205 2,9Operations on hernia 92297 3338 3,6Total number of urgent operations 184671 4403 2,4Operations on complicated hernia 12719 256 2,0Operations on uncomplicated hernia 79578 3101 3,8Hospitalization after 24 h., % 21,51 19,99


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POSTOP. MORTALITY IN UKRAINE

The quantity of cases of the late hospitalizations(> 24 h.) in Ukraine is almost identical with itsquantity in Khmelnytsky Region. And it averages 21% .

Postoperative mortality in Ukraine is 1.84, in theKhmelnytskyi region 1.29, and in case of latehospitalization it increases to 3.64 and 4.09,respectively (on 31%).


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SURGERY INDEXES


Region %Population, mln 45,63 1,32 2,9Total number of operations 2469168 67325 2,7Operations on abdominal organs 338557 10205 2,9Operations on hernia 92297 3338 3,6Total number of urgent operations 184671 4403 2,4Operations on complicated hernia 12719 256 2,0Operations on uncomplicated hernia 79578 3101 3,8Hospitalization after 24 h., % 21,51 19,99 Postoperative mortality, % 1,44 1,50 Postoperative mortality after 24 h., % 4,08 5,05


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KMELNYTSK. REGIONAL INDEXES

According to the "Basic health status indicatorsand activities of medical institutions of theregion", the ratio of population and surgicaloperation in the Khmelnytskyi region

in relation to the whole country is around 3%.


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SURGERY INDEXES


Region %Population, mln 45,63 1,32 2,9Total number of operations 2469168 67325 2,7Operations on abdominal organs 338557 10205 2,9Operations on hernia 92297 3338 3,6Total number of urgent operations 184671 4403 2,4Operations on complicated hernia 12719 256 2,0Operations on uncomplicated hernia 79578 3101 3,8Hospitalization after 24 h., % 21,51 19,99 Hospitalization after 24 h., % 21,51 19,99 Postoperative mortality after 24 h., % 4,08 5,05 Middle index 2,9


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A few words about femoral hernia

Femoral hernias (FH) are a relatively uncommon type,accounting for only 57 % of all hernias, however theyaccount for 34 % of all groin hernias in women. FH isnot always detected correctly preoperatively. Around60 % cases of FH present in the emergency situationwith high incidence of complications.


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A few words about femoral hernia

Women with FH and older than 65 years requireintestinal resection more often than men and youngpatients with other hernias. Patients who undergoresection have a higher overall complication raterelated to wound infections. Surgeons should paymore attention to this group of patients.

Gold standard of FH repair doesnt exist.Even the EHS guidelines (2009) dont give an answer

to this question. Socio-economic factors have not beenanalyzed in previously published reports on FH.


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THE AIM

To create a regional register and analyze theresults of femoral hernia repair in one of the 25provinces of Ukraine for the improving diagnosticand treatment algorithm and the consequences of

surgical treatment of patients with femoral herniain Ukraine.


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RESEARCH DESIGN

Retrospective (19902000) and prospective (20012011) multicenter clinical study was performed. Itincluded research and analysis of 2.075 cases offemoral hernia at 2.013 patients, which were operatedin the 24 surgical departments of Khmelnytsky regionfor the last 21 years.


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RESULTS

Women dominated among patients. They were 1678(83,4%).

0

500

1000

1500

2000

men

women

1 : 5


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RESULTS

81130

244

567

762

251

39

0

100

200

300

400

500

600

700

800

900

21 - 30 31 - 40 41 - 50 51 - 60 61 - 70 71 - 80 > 80

67,2 13,2

Age of patients ranged between 20 and 97 (67,2

13,2)years. 76,2% of patients were overthe age of60 years.


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RESULTS

In 1220 (60,5%) cases FH was right-sided, in 744 (36,8%) left-sided. 65 (3%) patients have two-sided FH. 28 (1,3%)patients had recurrent FH (in all cases after tensionhernioplasty by the Bassini-Lockwood method).

right-side

left-side

bilateral


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RESULTS

1016 (48,9%) patients were subject to immediate surgicaltreatment because of incarcerated FH and independentsetting of the strangulation (48,9%). Others were operatedbecause of uncomplicated reducible FH (36,0%) andirreducible FH (15,0%).

965

748

51

311

0

200

400

600

800

1000

1200

elective emergency

48,9%


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RESULTS

The incarceration of small intestine (628) was accompaniedby necrosis in 223 (35,5%) cases and required it resection.Peritonitis was diagnosed in 55 (5,4%) cases, phlegmon ofhernial sac in 50 (4,9%).

0 200 400 600 800

omentum

intestinum

epiploic append.

appendix

uterine append.

lipoma

cyst without resection

with resection

34,5%

40,2%

58,8%

87,5%

14,3%

40,0%

100%


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RESULTS

36,6% of operations was performed under local anesthesia. It wasused in every third 357 (35,2%) cases of the treatment ofincarcerated FH, but in 95 (26,5%) cases it caused the necessity tochange the type of anesthesia. Intravenous anesthesia was usedmore often (37,7%), and endotracheal anesthesia only in 21,4%cases. Regional anesthesia was used rarely (4,3%).

38%

21%

37%4%

spinal local intravenous endotracheal


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RESULTS

Infra-inguinal (femoral) approach was predominant, and itwas used in 1700 (81,9%) cases, median laparotomy on238 (11,5%). Together with laparotomy femoral approachwas done 170 times (71,4%). Trans-inguinal approach wasused on 137 (6,6%) patients, extended inguinal

herniolaparotomy, was used 19 times.

0

200

400

600800

1000

1200

1400

1600

1800

2000

approaches

trans-inguinal

laparotomy

infra-inguinal


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RESULTS

The average time of surgical interventions was 41,9 14,7 minthrue femoral approach, 109,2 38,4 and 62,6 30,5 min thrue

median laparotomy and inguinal approach, respectively. 17(0,84%) patients died after surgery because of decompensation ofthe circulatory and respiratory systems, peritonitis and neglectedintestinal obstruction.

0

200

400

600800

1000

1200

1400

1600

1800

2000

approaches

trans-inguinal

laparotomy

infra-inguinal

62,6 min 109,2 min

41,9 min


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RESULTS

To date the main method of FH repair in Khmelnytskyi region isBassini-Lockwood technique 1764 (85,0%). In 95 (4,6%) caseshernial gates were closed by Ruggi-Parlavecchio and McVaytechnique.

0

200

400

600

800

1000

1200

1400

1600

1800

2000

classic

oth

ers

tension-free

without

intr

aabdom

laparotomy

trans-ingu. approach

infra-ingu. approach

From 2004 the 114(5,5%) mesh implants

were used for FH repair.It were placed bothfrom the femoral andinguinal approaches(plug technique 72andpatch tecniques

42). In other 40 (1,9)cases hernial defect wasclosed by insidesuturing or stay openedbecause phlegmon.


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CONCLUSIONS

This is the first large-scale study in Ukraine, which made itpossible to realize problems of such a relatively rare anddangerous disease, as femoral hernia, to estimate the resultsof its surgical treatment, to develop the prospects for furtherimprovement of early and accurate diagnostics, and toimprove its treatment.

Over the last 10 years about 1.500 operations of femoralhernia were performed in Khmelnytsky Region. Suchoperations are practically a half of all interventionsperformed because of incarcerated hernia in the region. The

expected number of patients only with femoral hernia allover the country for the period 20012011 could reach50.000.


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CONCLUSIONS

In spite of general results improvement of the femoralhernia treatment, the analysis of the causes of unfavourableresults is of great interest. Unfortunately, we didnt find outthe exact number and reasons of femoral hernia recurrences.

Process of creating the registry of patients with femoralhernia is not completed and is planned to be continued in thefuture. It is only the first step and, in the opinion of theauthor, it should become an example and basis for thenational hernia register throughout Ukraine.


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RESEARCH DESIGN

I thank all my colleagues, district surgeons and nursesofficially for participation in creating data base.

mykytiuk s_from reg to nat (poland, 2012)

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