published_or_final_version / abstract / Medicine / Master / Doctor of Medicine

published_or_final_version / abstract / toc / Surgery / Master / Master of Surgery

The objective of this study was to investigate the quality of clinical outcomes in the surgical setting. Results of the study showed that there is no difference in infection rates between inpatient and outpatient hernia repair patients.

Background Surgery has traditionally been considered more expensive than many other health care interventions and with little impact on the burden of disease in a global perspective. One of the reasons behind this misconception is that the effects of surgical conditions and their treatment have not been factored into the equation. Cost-effectiveness analyses of surgical interventions have largely been missing. An estimated 20 million herniorrhaphies are carried out annually but over 200 million people suffer from groin hernias. Herniorrhaphy is one of the most commonly performed surgical procedures also in Low and Middle Income Countries (LMIC). However, the surgical repair method is not the same due to financial constraints. In high income countries a synthetic mesh is used and has reduced the risk of recurrence. This 125 USD mesh is too costly for the majority in LMIC. Mosquito mesh, which is cheaper but very similar to commercial meshes, is used in several settings but outcomes need to be investigated more extensively before this practice can be recommended in routine surgical service. The Aims of this thesis were to define the prevalence of groin hernia, to relate it to the surgical capacity, outcomes and costs of surgery in eastern Uganda and to investigate the feasibility and difference in cost and cost-effectiveness of replacing a commercial mesh with a mosquito mesh in groin hernia surgery. Methods Three studies (1-3) were carried out in eastern Uganda. 1: A cross sectional study investigating the prevalence of groin hernia in adult males in the Health and Demographic Surveillance Site (HDSS) in Iganga and Mayuge districts. 2: A facility based study with prospective data collection of all surgeries undertaken in the two hospitals providing surgery for the HDSS population. 3: A double blinded, randomised controlled trial comparing the outcomes of using a mosquito mesh relative using a commercial mesh in groin hernia surgery. Results 1: the prevalence of untreated groin hernia among the study participants was 6.6%. 2: the rate of groin hernia surgery was 17 per 100 000 population. Thus, less than 1% of the estimated number of cases of groin hernia in the catchment area of the two hospitals are operated per year. A herniorrhaphy costs around 60 USD to perform. This corresponds to a third of the cost of TB treatment and a 15th of the cost of HIV/AIDS treatment per year in Uganda. 3: No significant differences in terms of recurrence rates, post operative and chronic complications and patient satisfaction were demonstrated between the patients operated using the mosquito mesh and the commercial mesh. Cost-effectiveness was very high for both materials but total cost in the mosquito mesh group was 124 USD lower per surgery than in the commercial mesh group. Conclusion There is a vast unmet need for groin hernia surgery. Cost of surgery compares favourably with other health care interventions prioritised by the international organisations and funders. A superior technique can be used in groin hernia surgery at low cost, with high cost-effectiveness in a Low Income Country.

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 6 uppsatser.

Orientadores: Ângela Maria Moraes, José Alberto Fracassi da Silva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Química / Made available in DSpace on 2018-08-19T03:16:00Z (GMT). No. of bitstreams: 1 RammazzinaFilho_WalterAnibal_M.pdf: 10957404 bytes, checksum: d23a9aea438343039da493db09603556 (MD5) Previous issue date: 2011 / Resumo: O uso de implantes em cirurgias de correção da parede abdominal é freqüentemente necessário. Telas de poli(propileno) podem ser empregadas com sucesso para essa finalidade, possuindo boa aceitação tecidual e baixo custo. O uso deste tipo de biomaterial pode, porém, ocasionar a aderência indesejada entre tecidos e/ou entre órgãos como o fígado e os intestinos e a tela, resultando em dores abdominais, obstrução intestinal e infertilidade. Neste contexto, o objetivo deste trabalho foi o de desenvolver uma estratégia de recobrimento de telas de poli(propileno) enfocando a deposição de soluções de quitosana de massa molar baixa e média e de polietilenoglicol (PEG) de massa molar igual a 1000 Da por electrospinning. Para fins de comparação, telas de poli(propileno) foram alternativamente recobertas por imersão com diferentes soluções combinando quitosana e PEG. Nos estudos de recobrimento via electrospinning, foram avaliadas as variáveis tipo de solvente para a dissolução da quitosana e do PEG, vazão de solução de recobrimento, proporção entre quitosana e PEG, diferença de potencial usada durante a deposição e distância entre a tela e o jato de injeção. As telas recobertas através da imersão em soluções de quitosana a 1% (tanto com a de baixa massa molar quanto a com massa molar média) e em soluções de quitosana misturada ao PEG também com concentração de sólidos total de 1% apresentaram-se satisfatórias para fins de barreira física em cirurgias de hérnia, considerando-se o aspecto, a uniformidade, os valores médios de espessura (de 1140 e 990 mm, respectivamente), a perda de massa em fluido corpóreo simulado (5,1 e 8,9%, respectivamente) e a capacidade de absorção do mesmo fluido (0,76 e 0,59 g/g, respectivamente). Já o recobrimento por electrospinning resultou no depósito de fibras emaranhadas na superfície das telas, que apresentaram, então espessuras finais variando entre 581 e 612 mm, perdas de massa entre 4,9 e 9,2% em fluido corpóreo simulado, capacidade de absorção de 0,17 a 0,36 g/g em fluido corpóreo simulado e diâmetros de fibras de 20,9 a 92,2 mm. O recobrimento via electrospinning resultou em biomateriais menos espessos e com menos massa associada, com bom potencial de uso na aplicação pretendida / Abstract: The use of implants in surgical correction of the abdominal wall is frequently required. Polypropylene meshes can be successfully employed for this purpose, having good tissue acceptance and low cost. The use of this biomaterial, however, can lead to undesired adhesion between tissues and/or between organs such as the liver and intestines and the mesh, resulting in abdominal pain, bowel obstruction and infertility. In this context, the objective of this work was to develop different coatings of polypropylene meshes, focusing on the deposition of solutions of chitosan of low and medium molecular weight and polyethylene glycol (PEG) of molecular weight equal to 1000 Da by electrospinning. For comparison, polypropylene meshes were alternatively coated by immersion in different solutions combining chitosan and PEG. In the studies of coating via electrospinning, the effect of the variables type of solvent for the dissolution of chitosan and PEG, coating solution flow rate, chitosan to PEG mass ratio, the potential difference used during the deposition and the distance between the mesh and the injection jet were evaluated. Meshes coated by immersion in chitosan (both with low and medium molar mass) and PEG solutions with total solids concentration of 1% were satisfactory for purposes of physical barrier in hernia surgery, considering aspect, uniformity, mean thickness (1140 and 990 mm, respectively), mass loss (5.1 and 8.9%, respectively) and the capacity of fluid absorption (0.76 and 0.59 g/g, respectively). Coating by electrospinning resulted in the deposition of entangled fibers on the surface of the meshes, which had final thickness ranging between 581 and 612 mm, losses of mass between 4.9 and 9.2% in simulated body fluid, absorption capacity of 0.17 to 0.36 g/g in the same fluid and fiber diameters from 20.9 to 92.2 mm. Coating the meshes via electrospinning resulted in thinner biomaterials and with less associated mass, with good potential for use in the intended application / Mestrado / Desenvolvimento de Processos Biotecnologicos / Mestre em Engenharia Química