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)
Left to right Dr. Reinpold, Dr. Cuenca and Dr. Fitzgibbons
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.
Fond des Blancs, Haiti, January 2018
/in Haiti, Missions /by herniahelpadminHRFU Hernia Mission at St. Boniface Hospital Fond des Blancs Haiti 2018
The Saint Boniface Hospital in Fond Des Blancs Haiti operates upon 300 patients a month doing mostly emergency operations. They therefore had a long waiting list of elective patients many of which had hernias. Dr. Tommy Lee, a surgeon that has lead an HRFU team and been on other HRFU trips came with disposable equipment to operate upon 24 hernia patients and to train and observe inguinal hernia operations performed by 2 of our previous trainee surgeons Dr. Einstein Bellora and Dr. Saint Cyr. Both were tested with the OPRS rating scale on 4 and 5 patients respectively and did well. They will be given more mesh.
Dr. Luther Ward and Dr. Padovany the head general surgeons and their staff were excellent hosts. They also operated on hernias that week so a total of 48 hernia patients were operated upon that week.
This type of trip has high impact with only one team member and the model will be followed in the future as well as teams of 6-8 team members when hospital personnel can be used. The only concern is short turn over times, so the normal volume of cases can be completed.
Paraguay, 2017
/in Missions, Paraguay /by herniahelpadminHernia Mission to Paraguay November 20-24, 2017
The hernia mission was planned and organized by:
Team Germany:
Team USA:
Left to right Dr. Reinpold, Dr. Cuenca and Dr. Fitzgibbons
Team Asunción University Hospital going to Santa Rosa:
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:
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.
Dominican Republic, November 2017
/in Dominican Republic, Missions /by herniahelpadminHRFU ILAC 2017 Mission trip
The team functioned well in the outstanding ILAC facility. New surgeons included Dr. Rigoberto Alvarez, and Dr. Alejandro Pena from Guadalajara Mexico. Dr. Larry Raynor was the new head of anesthesia and did an excellent job. Many team members returned and we performed 105 hernia operations. One patient with a large inguinal scrotal hernia did have an early postoperative hematoma and required re-operation. There were challenging new customs equipment restrictions that were surmounted at the last minute with much effort.
The entire 2017 team
The Pre Op Team with Sylvia the cooperadora
One of our classic Dominican older patients
Port-au-Prince, Haiti, 2017
/in Haiti, Missions /by herniahelpadminMission Summary St. Francois de Sales – October 2017
Hernia Repair for the Underserved Nick Carter
Introduction
From 10/1/2017 to 10/7/2017, The Centre-Hospitalo-Universitaire Saint Francois de Sales (CHUSFS) welcomed a group of 16 American medical providers for a training mission in hernia surgery. The visitors included two surgeons, two surgical residents, a pediatric anesthesiologist, a critical care pulmonologist, CRNA, four OR nurses, and five PACU nurses. The intent of the mission was to train Haitian surgeons in Lichtenstein hernia repair for adult patients, pediatric inguinal hernia repair, and laparoscopic inguinal hernia repair. The mission also presented an opportunity to establish proof of concept for laparoscopy and complex ventral hernia repair at the CHUSFS.
Summary of events
In total, 77 patients received operations including 25 children. There were 15 ventral hernia repairs and 10 laparoscopic cases performed. Haitian trainees included Dr. Jacklin Mertus, an attending surgeon from CHUSFS, and Dr. Rolph Richeme, chief of surgery at Hospital Raoul Pierre Louis in Carrefour. Trainers included Dr. David Chen of UCLA, Dr. Robert Cusick of Children’s Hospital and Medical Center in Omaha, and Dr. Jean-Fritz Jacques of the Hospital of the State University of Haiti (HUEH). Two surgeons from HUEH, Dr. Jacques and Dr. Silvio Augustin, underwent additional training in advanced laparoscopic techniques.
Fig 1. Dr. Richeme performing a Lichtenstein hernia repair with Dr. Jacques.
Anesthesia and nursing providers from the CHUSFS and HRFU collaborated to provide safe perioperative care for all patients. Surgery and anesthesia residents from HUEH also participated in clinical care and training. There were no reoperations or immediate complications.
Fig 2. Ms. Chantal Corrioland (CHUSFS Head OR Nurse), Dr. Cynthia Ferris (HRFU Pediatric Anesthesiologist), and Dr. Johanne Duchatellier (CHUSFS Anesthesiologist)
Discussion and Future Opportunities
This visit represented the first Hernia Repair for the Underserved (HRFU) clinical mission to the CHUSFS. A brief discussion of opportunities for future collaboration:
Creating a Center of Excellence
The CHUSFS administrators expressed continued interest in hosting a permanent national referral center for patients with complex hernia disease. The infrastructure at the CHUSFS supported a busy clinical week. Overall, the laparoscopic equipment is in good condition and image projection is satisfactory for safe performance of operations (see Fig 1). The biggest challenge was maintaining an adequate supply of CO2 for insufflation as well as compatible tanks, regulators, and hoses. We found this problem to be surmountable through teamwork, communication, and reducing our CO2 consumption by using a hand-pump for insufflation as much as possible.
Fig 3. Dr. Jacques performing a laparoscopic inguinal hernia repair
Elevating the profile of the CHUSFS in Port-au-Prince and provinces
the CHUSFS leadership arranged for a visit from a television crew from Radio Tele Soleil, the television and radio station belonging to the Archdiocese of Port-au-Prince. Msgr. Aris expressed an interest in planning increased media exposure and perhaps a formal press conference during future missions.
Fig 4. Drs. Eustache, Carter, Telemaque, and Chen prepare for a television interview with Radio Tele Soleil.
Skills Lab and Additional Collaboration
Dr. Jean Gary Doucet, president of the Haitian Association of Surgery, expressed interest in developing a skills lab that would allow Haitian surgeons from various institutions to develop laparoscopic and open surgical techniques. Low-tech laparoscopic trainers could be sited at HSFS to simulate intracorporeal suturing, knot-tying, and other fundamental skills. There may also be an opportunity for increased collaboration between HUEH and the CHUSFS surgeons to identify patients who are candidates for laparoscopic repair. A weekly hernia clinic, historically held on Saturdays at HUEH, might be transitioned to the CHUSFS to develop laparoscopic experience for surgeons from both institutions.
Additional Items and Next Year
Haitian staff feedback will be obtained and future trips will be planned. A Memorandum of Understanding between CHUSFS and HRFU is in discussion.
Ouanaminthe, Haiti, 2016
/in Haiti, Missions /by herniahelpadminMao Salcedo, Dominican Republic, 2016
/in Dominican Republic, Missions /by herniahelpadminMirebalais, Haiti, 2016
/in Haiti, Missions /by herniahelpadminParaguay, 2016
/in Missions, Paraguay /by herniahelpadminGuatemala, October 2016
/in Guatemala, Missions /by herniahelpadminUniversity of Nebraska Surgery on Sunday: Omaha, NE, June 2016
/in Missions, USA /by herniahelpadminUNMC Bellevue Charitable Hernia Mission 2016
The Surgery on Sunday model was used and after University of Nebraska Medical Center administrative approval and multiple organizational meetings a date was set, June 3. Dr. Hans Dethlefs at the One World Clinic evaluated all patients pre-operatively and eventually we performed 11 hernia operations in one. Dr. Sam Cemaj, Dr. Tiffany Tanner and Dr. Arika Hoffman performed the surgery. Recovery was uncomplicated in the hospital and two weeks postoperatively the patients are doing well.
The facility is modern and very well kept and managed making patient comfort easily possible.
The Anesthesia staff, Surgeons and medical students who participated. Dr. Cemaj on the left is the team leader.
A nice article appeared in the World Herald about a grateful patient who had made a good addiction recovery before undergoing surgery. Thanks to Rosanna Morris, the CEO of Nebraska Health Systems for her generous support of the initiative.