Paraguay, 2023
Hernia Mission to Paraguay November 20-24, 2023
The hernia mission was planned and organized by:
Prof. Dr. Osmar Cuenca Torres, Director of the Department of Abdominal Wall Surgery del Hospital Universitario and Dean of the Faculty of Medical Sciences of the National University of Asunción. Prof. Cuenca is Paraguay´s leading expert for complex abdominal wall hernia repair. He has a vast experience of several hundred cases with preoperative Botox A infiltrations and preoperative progressive pneumoperitoneum. Apart from this he has established the MILOS technique in his department.
and
Dr. Wolfgang Reinpold, Director of the Hamburg Hernia Center and Department of Surgery, Reference Center of Abdominal Wall Surgery, Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg, Germany.
Visiting professor of the Faculty of Medical Sciences of the National University of Asunción.
All hernia operations were performed on poor and indigent patients who otherwise had no access to and were unable to afford necessary modern standard mesh repair of their hernias. Most of the patients suffered from their hernia for many years and some of them were no longer able to work at all, since many occupations, especially in rural areas require physical fitness.
Many of the patients came from the district of Santa Rosa del Aguaray, northern department of San Pedro which figures among 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. Originally three operation days were planned in the General Hospital of Santa Rosa del Aguaray, which is located 250 km to the northeast of Asunción.
Several weeks before our mission the patients were all very well selected and prepared by Prof Cuenca, who drove two times six hours from Asuncíon to Santa Rosa del Aguaray to examine, select and prepare the patients.
Due to internal infrastructural problems in the Santa Rosa hospital the patients had to be transferred to Asunción for their operations. Many patients spoke only Guarani and hardly any Spanish. Since Spanish and Guaraní are the official Paraguayan languages the hospital staff and doctors were able to communicate with the patients and translate.
Hernia surgeries were performed in the following institutions:
Hospital of the National University of Asunción
The Hospital of the National University of Asunción is modern and well equipped including good laparoscopic facilities. In this institution all kinds of complex abdominal wall hernia operations can be performed. The facilities are appropriate for a hernia center of excellence.
Operations in the Military Hospital, Asunción
The Military Hospital of Asunción is set in an old building in the historic center of Asunción. Due to a scarcity of military patients and a specific need in the public health sector it was recently opened for the treatment of non-military patients. The hospital has good facilities for hernia repair. The operation rooms are spacious, basic but adequately equipped.
On November 20 we had the great honor to meet the Paraguayan Minister of Health Maria Teresa Barán Wasilchuk. She visited us in the operation section of the Military Hospital and thanked us for the HRFU project.
The staff of both, the Hospital of the National University of Asunción and Military Hospital were very professional, well trained, helpful, and friendly.
November 20 and 21, 2023: Military hospital of Asunción, two operating rooms (Prof. Dr. Osmar Cuenca (OC) Dr. Wolfgang Reinpold (WR))
November 22 and 24, 2023: University Hospital of Asunción, two operating rooms (OC and WR)
The operations were performed mainly under peridural or local anesthesia with sedation. The Paraguayan anesthesiologists were very well trained and did a great job. We operated on 40 patients (7 women and 33 men) with a total of 57 hernias (50 groin hernias, 7 umbilical hernias). Ten patients suffered from bilateral groin hernias and 15 patients had scrotal hernias of which 7 were very large. Nine of the scrotal hernias were not completely reducible (chronically incarcerated, 3 cases of reversible bowel strangulation, no bowel resction required). Four patients with scrotral hernias required partial omentum majus resection. There were no intra operative complications.
Most of the patients went home on operating day, all remaining patients were discharged on the next day. The early postoperative follow-up of patients from district of Santa Rosa del Aguaray was performed by local doctors or health professionals. To our knowledge there were no complications except for three minor hematomas. There were no reoperations. (OC: 20 patients, 26 groin hernias, 7 scrotal hernias, 4 umbilical hernias
WR: 20 patients, 24 groin hernias, 8 scrotal hernias 3 umbilical hernias)
Eight final year residents successfully participated in the HRFU-One day Lichtenstein training course:
Dra. Noelia Campuzano (OC)
Dra. Roun Kim (WR)
Dra. Maria del Mar González (WR)
Dra. Maria José González (OC)
Dr. Francisco Molas (OC)
Dr. Victor Samaniego (WR)
Dr. Oscar Solis (WR)
Dr. Diego Vera (OC)
Hernia mesh was donated by the German companies GFE Dynamesh and PFM, suture material and other operating room materials were provided by donations of Hamburg citizens, Germany. The donations were organized by Dr. Reinpold.
The 2023 mission to Paraguay was very successful. The operations were performed very professionally and in good spirit. We operated exclusively on indigent patients. The patients were very thankful.
I thank Prof. Dr. Osmar Cuenca and his team very much for their outstanding and dedicated organization and excellent surgeries.
Dr. Wolfgang Reinpold
