Paraguay, 2017

Hernia Mission to Paraguay November 20-24, 2017

The hernia mission was planned and organized by:

• Prof. Dr. Osmar Cuenca Torres, Director of the Department of Abdominal Wall Surgery, Hospital de la Universidad Nacional de Asunción, Paraguay.
• Dr. Victor Luraschi, Director of the Department of General Surgery, Hospital Regional de Luque, Asunción, Paraguay
• Dr. Wolfgang  Reinpold, Director of the Department of Surgery and Reference Center of Abdominal Wall Surgery, Gross Sand Hospital, Teaching Hospital of the University of Hamburg, Germany

Team Germany:

• Dr. Martin Wiese, Director of the Department of General and Abdominal Wall Surgery, Gesundheitszentrum Kelkheim, Germany
• Ole Reinpold, assistant of logistics, supply and translator
• Bosse Reinpold, assistant of documentation
• Dr. Wolfgang  Reinpold, Director of the Department of Surgery and Reference Center of Abdominal Wall Surgery, Gross Sand Hospital, Teaching Hospital of the University of Hamburg, Germany (Team leader Germany)

Team USA:

• Robert J. Fitzgibbons Jr., MD, Professor of Surgery, Chair and Director of the Department of General Surgery Creighton University Hospital, Omaha, Nebraska, USA (November 20 – 21, 2017)

Team Asunción University Hospital going to Santa Rosa:

• Prof. Cuenca Torres
• Dra. Jasmin Coronel, resident
• Dr. Ricardo Aved, resident
• Dr. Pablo Berra, resident
• Dr. Ever Sosa, resident
• Dr. Baudillo Salazar, resident
• Aracelia  operating-room nurse
• Nuvia  operating-room nurse

Hernia mesh, suture material and other operating room materials including some sets of instruments were provided by Dr. Wiese, Prof Fitzgibbons and Dr. Reinpold.

All hernia operations were performed on indigent patients. Most of the patients in Santa Rosa del Aguaray spoke only Guarani and hardly any Spanish. Since Spanish and Guaraní are the official Paraguayan languages the local hospital staff and doctors were able to communicate with the patients and translate.

Hernia operations were performed in the following institutions:

• November 20 and 21, 2017: University Hospital of Asunción, two operating rooms (Dr. Cuenca, Dr. Fitzgibbons, Dr. Reinpold (November 21))
• November 20 – 24, 2017: Hospital de Luque, Asunción, two operating rooms (Dr. Wiese, Dr Reinpold (November 20))
• November 22 – 24, 2017: Hospital Santa Rosa del Aguaray, two tables in one operating room (Dr. Cuenca, Dr. Reinpold)

The patients were all very well selected and prepared by Prof Cuenca and Dr Luraschi. Prof Cuenca drove two times six hours from Asuncíon to Santa Rosa del Aguaray to examine, select and prepare the patients.

The mission started on Monday, November 20, 2017 with an academic session in the Faculty of Medical Sciences of the National University of Asunción. Prof. Cuenca gave a lecture on the current status of hernia surgery in Paraguay. Prof. Fitzgibbons presented on the philiosphy, past missions, achievements and plans of HRFU. He also addressed the plan of establishing a HRFU hernia center of excellence in Paraguay which was well received by the Faculty.  Dr. Reinpold gave a talk on the new developments of abdominal wall hernia surgery including his mininmal invasive Sublay (MILOS) technique.

 

At the end of the session Prof. Fitzgibbons and Dr. Reinpold were honored and awarded the title of Visiting Professor of the Medical Faculty of the National University of Asunción.

Immediatedly after the lectures hernia surgery started.

Operations:

The Hospital of the National University of Asunción is modern and well equipped including good laparoscopic equipment. In this institution all kinds of complex abdominal wall hernia operations can be performed. The facilities are appropriate for a hernia center of excellence.

Prof. Cuenca Torres is Paraguay´s leading expert for complex abdominal wall hernia repair. He has an experience of about 80 cases with preoperative Botox A infiltrations and approximately 50 cases of preoperative progressive pneumoperitoneum. Apart from this he has established the MILOS technique in his department.

In two days Prof. Cuenca, Prof Fitzgibbons and Dr. Reinpold performed 20 hernia operations: Fourteen inguinal hernia Lichtenstein operations (three bilateral), one open transinguinal preperitoneal mesh repair (TIPP) in a femoral hernia, three MILOS operations of umbilical and epigastric hernias, two MILOS operations of large incisional hernias. Three residents were trained in Lichtenstein repair. Most of the inguinal hernias were large scrotal hernias.

All patients went home either on the day of surgery or the next day.

Operations in the Regional Hospital of Luque, Asunción

The Departement of Surgery at Luque hospital is a very well organized by the chief of the department Dr. Victor Luraschi. The equipment is satisfactory. The team in Luque Hospital consisted of Dr Victor Luraschi, the staff surgeons and hernia specialists Dra. Montserrat Villasboa, Dra Rita Miranda and Dr. Martin Weise. Dr. Reinpold operated in Luque Hospital only on November 20. In five operating days 53 hernia operations were performed on 48 patients: 39 Lichtestein operations, two TIPP mesh operations in femoral hernias, 8 Sublay operations of umbilical and epigastric hernias (4 of those MILOS repairs), 2 sublay operations of incisional hernias, 2 suture repairs of umbilcal hernias. Three final year residents were trained.

Operations in General Hospital of Santa Rosa del Aguaray

The Santa Rosa del Aguaray is located 250 km to northeast of Asunción. The General Hospital of Santa Rosa del Aguaray was built with support of the Korean International Cooperation (KOICA) and inaugurated in 2012. It is a regional hospital with good basic equipment. It’s catchment area includes 61,000 people of Santa Rosa del Aguaray district which is part of the northern department of San Pedro. The district one of the poorest regions of Paraguay with a rural population of 93%. About 40% of the people live in poverty and 15% in extreme poverty. Eighty percent of the population speak Guaraní and about 20% Yopara, a mixture of Guaraní and Spanish.

 

Prof. Cuenca organized a bus for our trip to Santa Rosa which left Asunción Wednesday, November 22, at 5am. The trip took us more than 6 hours on sometimes very bumpy roads. We stayed at the Cristal Hotel some 500 meters from the hospital. After our arrival at Santa Rosa Hospital we carried about 20 boxes of materials and equipment to the operating rooms.  We could use only one operating room since the second one was reserved for emergencies. Fortunately we were able to work on two tables in our large OR. We started surgery after a quick lunch and welcome reception by the hospital administration. In 3 operating days 32 hernia operations were performed on 29 patients; 25 Lichtenstein repairs, one TIPP mesh operation for a femoral hernia, 4 Sublay MILOS operations for 2 umbilical, one epigastric and one incisional hernia, and 2 suture repairs for umbilcal hernias. Two 5th  year residents and one qualified general surgeon were trained.

In one working week a total 105 hernia operations were performed. There were 78 Lichtenstein operations, 4 TIPP operations, 14 Sublay operations of umbilical and epigastric hernias, 5 Sublay operations of incisional hernias, 4 suture repairs of umbilical hernias.

Two thirds of the inguinal hernias were mostly big scrotal hernias, 10% of the inguinal hernias were recurrent hernias. Most of the patients went home on operating day, all remaining patients were discharged on the next day. The early postoperative follow-up was performed by local doctors or health professionals. Except for some minor hematomas there were no complications. To our knowledge no reoperations were necessary.