Repair of inguinal hernia under local anaesthesia in high risk patient

Abstract EN

Inguinal hernia repair is a common operation in general surgery and can be performed under local, regional or general anaesthesia, The American Society of Anaesthesiologists (ASA) 3 and 4 patients are generally considered unsuitable for day case hernia repair, high risk for surgery under general or regional anaesthesia, so we study surgery under local anaesthesia for those high risk group.

Aim : Aim of our study were to look at the high risk patient suitability for day-case repair of inguinal hernia under local anaesthesia(LA).

Patient and method : Between January 2007 and January 2009, 75 patients with unilateral inguinal hernia ASA 3 and 4 underwent prospective study for repair of hernia under local anaesthesia by plug and patch of mesh.

Result : 75 patients with inguinal hernia were operated on under local anaesthesia, median age 68 (range 40 to 102) years, 29 direct type, 43 indirect type, 3 direct and indirect type (pantaloon type) , the median body weight 53kg (ranged 45 to 105 kg).

The duration of procedures were 30 to 80 minutes (average 50 minutes).

3 of cases with big irreducible hernia perioperatively required IV diazepam 5 mg and one of them requires IV pethedine 50mg, 1 patient developed superficial wound infection, 3 patients developed subcutaneous seroma, 9 patients had ecchymosis at site of infiltration and operation, 3 patients developed scrotal haematoma, no one develop urinary retention, and no recurrence during follow up period and no mortality.

The median period of follow up 6 months (range 4- 15 months), Waiting time for our study 1 to 2 week compared to patient required GA 2-3 months.

Conclusions : Repair of inguinal hernia under LA in high risk patient seems to be safe and feasible with an acceptable morbidity.

Obesity in itself is not an absolute contraindication for LA and the waiting times are acceptable and can be done as day case surgery.