• 14 JUN 12
    • 0

    “One day surgery ” is a well established concept in the western medical world because it can solve problems that, until recently, were the prerogative of the hospital, with lesser costs and hassle. There are some clear areas where medical and technological advances have enabled the transition from classical surgery to one day surgery. Thus, the appearance and development of laparoscopy have made a range of conditions such as gallstones, acute appendicitis, ovarian cysts, etc. to became one day surgery procedures with hospitalization times of hours instead of days. Sometimes a hospitalization of two days in Europe, after the same surgery, is up to 12 hours in the U.S., where patient tracking system at home is best developed.

         Hernia one day surgery, be it inguinal, femoral or umbilical, is thoroughly feasible especially if we are using the modern techniques promoted by Lichtenstein, or any other tension-free technique, solving the parietal defect without tension by using synthetic mesh and operating under local anesthesia. After the procedure the patient could go home on foot shortly after surgery, with no postoperative pain and rapid recovery and resumption of professional activities.

    Another one day surgery procedure is hydrostatic varicose veins surgery, phlebology making progress both in loco-regional anesthesia, and in micro-surgery phlebectomy, Muller phlebectomy. Associating compression stocking also helps fast mobilization and recovery.

    Also proctology – hemorrhoids, fissures, etc.  resolves all pathology without hospitalization, using minimally invasive techniques as elastic ligatures, sclerotherapy or cryosurgery, infrared coagulation or surgical procedures under local anesthesia.

    Responsible for supporting one day surgery in the West are particularly insurance companies (who want to spend less on treating diseases, sometimes hospitalization is significantly more expensive than operation itself) and patients (who, prefer to get home sooner not being very fond of hospitals rooms).  One day surgery appeared also in Romanian surgical services, but here we do not have private insurance operators so only the patients promote and insists for this approach.  It is fair also to point out that the romanian state own medical care system are not on pair with western hospitals, both as number of medical personal and infrastructure.

        Thus, first steps were made in surgery for varicose veins, where there is already experience in centers in Bucharest, Cluj and Timisoara, where all sorts of venous diseases are sort out, with minimally invasive techniques, without hospitalization. Because venous disease is widely widespread (30% of the population), the appearance of modern phlebology practices is very beneficial for the patients and for the state, decreasing the health care costs.

    One day surgery does not mean, however, a superficial, vegan style approach, without a proper diagnosis and modern techniques does not mean a series of incisions that bind small veins from place to place, (CHIVA), in which cases  reoccurrence is the rule, sometimes in a few months, because the original cause for the disease was left in place. Diagnosis of venous disease is more demanding now and it involves the use of modern equipment, Doppler, eco Doppler Triplex or digital phlebography. Only an accurate diagnosis can permit to choose the wright intervention to solve the cause and minimize the risk of relapse, while pursuing and achieving other desired outcomes, cosmetics, aesthetic, painless and the patient go home soon after surgery.

    Another surgical condition on the one day surgery list in Romania is the hernia surgery. Using tension free techniques it allowed us to operate an inguinal hernia in the morning and release the patient in the afternoon. Operations are performed under local anesthesia without hospitalization, with the use of synthetic mesh, tension-free, with good results and are very well received by patients.

       Proctology also benefits from one day surgery for a series of surgical conditions, outpatient regime seems to lower the postoperative stress and pains.

        Laparoscopic surgery needs hospitalization, but the duration decreased in some places at two days in many diseases. Shortening these period to one day may be feasible if we can implement the tracking system at home by general practitioners.

    Dr. Eduard Ursuleanu, General Surgeon, ProEstetica Medical Center

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