Emergency inguinal hernia repair under local anesthesia: a 5-year experience in a teaching hospital

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Abstract

Background

Local anesthesia (LA) has been reported to be the best choice for elective open inguinal hernia repair because it is cost efficient, with less post-operative pain and enables more rapid recovery. However, the role of LA in emergency inguinal hernia repair is still controversial. The aim of this study is to investigate the safety and effectiveness of LA in emergency inguinal hernia repair.

Methods

All patients underwent emergency inguinal hernia repair in our hospital between January 2010 and April 2014 were analyzed retrospectively in this study. Patients were divided into LA and general anesthesia (GA) group according to the general conditions of the patients decided by anesthetists and surgeons. The outcome parameters measured included time to recovery, early and late postoperative complications, total expense and recurrence.

Results

This study included a total of 90 patients from 2010 to 2015. 32 patients (35.6 %) were performed under LA, and 58 (64.4 %) were performed under GA. LA group has less cardiac complications ( P = 0.044) and respiratory complications ( P = 0.027), shorter ICU stay ( P = 0.035) and hospital stay ( P = 0.001), lower cost ( P = 0.000) and faster recovery time ( P = 0.000) than GA group.

Conclusion

LA could provide effective anesthesia and patient safety in emergency inguinal hernia repair.

Related collections

Most cited references 23

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Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial.

Pär Nordin, Henrik Zetterström, Hans-Erik Nilsson … (2003)

In specialised centres, local anaesthesia is almost always used in groin hernia surgery; whereas in routine surgical practice, regional or general anaesthesia are the methods of choice. In this three-arm multicentre randomised trial, we aimed to compare the three methods of anaesthesia and to determine the extent to which general surgeons can reproduce the excellent results obtained with local anaesthesia in specialised hernia centres. Between January, 1999, and December, 2001, 616 patients at ten hospitals, were randomly assigned to have either local, regional, or general anaesthesia. Primary endpoints were early and late postoperative complications. Secondary endpoints were duration of surgery and anaesthesia, length of postoperative hospital stay, and time to normal activity. Analysis was by intention to treat. Intraoperative tolerance for local anaesthesia was high. In the early postoperative period, local anaesthesia was superior to the other two types with respect to almost all endpoints. At 8 days' and 30 days' follow-up, there were no significant differences between the three groups. Although the mean duration of surgery was longer, the total anaesthesia time-ie, time from the start of anaesthesia until the patient left the operating room-was significantly shorter than it was for regional or general anaesthesia. Local anaesthesia has substantial advantages compared with regional or general anaesthesia, such as shorter duration of admission, less postoperative pain, and fewer micturition difficulties. The favourable results obtained with local anaesthesia in specialised hernia centres can, to a great extent, be reproduced by general surgeons in routine surgical practice.

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Open "tension-free" repair of inguinal hernias: the Lichtenstein technique.

I. Lichtenstein, P Amid, A. Shulman (1996)

To report our results with an open, tension free technique of repairing primary inguinal hernias using polypropylene (Marlex) mesh under local anaesthesia. Open study. Specialist clinic, USA. 3480 Out of a total of 4000 men whose primary inguinal hernias were repaired between June 1984 and June 1995. Hernia repair involving total reinforcement of the transversalis fascia with mesh. Morbidity, particularly recurrence. A total of 1776 (44.4%) were direct hernias, 1724 (43.2%) indirect, and 500 (12.5%) a combination; 456 (11.4%) were sliding hernias. Patients were followed up for a mean of 51/2 years (range 1-11) and 520 were lost to follow-up, leaving 3480 (87.0%) for analysis. All patients followed up were examined by a physician. There were five recurrences (0.1%), four at the pubic tubercle and one in which the mesh had torn away from the inguinal ligament because it was too narrow. There has been one recurrence in the last six years of the study. One patient developed orchitis. There was one case of postoperative neuralgia. There were no seromas that required aspiration. Most patients had returned to work within two weeks, including the manual workers. Repair of primary inguinal hernias under local anaesthesia with the open, tension-free technique using polypropylene mesh results in acceptable morbidity, and appreciable reductions in postoperative discomfort, duration of hospital stay, recurrence rate and costs.

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Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults.

Berit Strand, Poul Juul, Torsten Asmussen … (2011)

The nationwide Danish Hernia Database, recording more than 10,000 inguinal and 400 femoral hernia repairs annually, provides a unique opportunity to present valid recommendations in the management of Danish patients with groin hernia. The cumulated data have been discussed at biannual meetings and guidelines have been approved by the Danish Surgical Society. Diagnosis of groin hernia is based on clinical examination. Ultrasonography, CT or MRI are rarely needed, while herniography is not recommended. In patients with indicative symptoms of hernia, but no detectable hernia, diagnostic laparoscopy may be an option. Once diagnosed, hernia repair is recommended in the presence of symptoms affecting daily life. In male patients with minimal or absent symptoms watchful waiting is recommended. In females, however, repair is recommended also in asymptomatic patients. In male patients with primary unilateral or bilateral groin hernia the preferred method is mesh repair, either at open surgery (Lichtenstein) or laparoscopically, irrespective of age. Conventional tension-producing methods like Bassini, McVay or Shouldice are no longer recommended in a routine elective setting. Whether repair should be done by open or laparoscopic technique, depends on local expertise, economical considerations and patient preference. Compared to the Lichtenstein operation laparoscopic repair is associated with less acute pain and faster recovery. Furthermore, available data suggest less chronic long-term pain after laparoscopic repair. In female patients laparoscopic repair is the recommended method. In patients with recurrent hernia laparoscopic repair is preferred in patients with a previous open repair, while patients with recurrence after laparoscopic repair should undergo open mesh repair. In open repair it is recommended to use a mesh secured with a nonabsorbable monofilament suture. In laparoscopic repair a mesh without a slit and with a minimum size of 15 by 10 cm is used. For mesh fixation absorbable or nonabsorbable tacks or glue can be used. Elective surgery for groin hernia should be performed in an outpatient setting, using cost-effective local anaesthesia in open mesh repair and general anaesthesia for laparoscopic repair. Spinal anaesthesia is not recommended. Routine prophylactic antibiotics are not indicated. In the early convalescence period there are no physical restrictions. These guidelines will also be available at the website for the Danish Hernia Database (www.herniedatabasen.dk). The guidelines will be updated when new substantial evidence becomes available.

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Author and article information

Contributors

Tao Chen: dr_chentao78@163.com

Yunhe Zhang: zyhe31@163.com

Haolu Wang: whaolu@163.com

Qihong Ni: niqihong1989@163.com

Linhua Yang: yanglinhua1981@126.com

Qiwei Li: dr_liqiwei@163.com

Jian Wang: +86 21 68383773 , dr_wangjian@126.com

Journal

Journal ID (nlm-ta): BMC Anesthesiol

Journal ID (iso-abbrev): BMC Anesthesiol

Title: BMC Anesthesiology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2253

Publication date (Electronic): 19 March 2016

Publication date PMC-release: 19 March 2016

Publication date Collection: 2015

Volume: 16

Electronic Location Identifier: 17

Affiliations

[ ]Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 S. Dongfang Road, Shanghai, 200127 China

[ ]Therapeutics Research Centre, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD 4102 Australia

Article

Publisher ID: 185

DOI: 10.1186/s12871-016-0185-2

PMC ID: 4799842

PubMed ID: 26994892

SO-VID: 1b22f01f-163b-469f-a498-640942b26dd4

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.