Inguinal Hernia Repair with Local Anesthesia in the Outpatient—10 Year Experience

Flavio Antonio de Sá Ribeiro, Baltazar de Araujo Fernandes, João Pedro de Araujo Simões Corrêa

General Surgery Service, Hospital Geral de Bonsucesso, Rio de Janeiro, Brazil.
Surgery of UNIFESO, Teresopolis, Brazil Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil.

DOI: 10.4236/ijcm.2014.512088                

Abstract

Objective: To demonstrate the feasibility of inguinal hernia repair with local anesthesia in an out-patient regime, with safety, efficacy and short learning curve. Methods: We prospectively evaluated 1186 patients undergoing inguinal hernia repair under local anesthesia on an outpatient basis between November 2004 and March 2014. Of the total number of hernias surgically treated in this period, 755 were operated on the right, 394 on the left and 37 bilateral. We used clinical, surgical and psychosocial criteria for inclusion in the procedure. The parameters for exclusion were complex, irreducible or recurrent hernia, obesity (BMI greater than 30 kg/m²), patient’s refusal and psychiatric disorder. All patients underwent elective surgery and were analyzed regarding surgical outcome, complications and hospital stay. Results: All operations were completed successfully. In no case there was a need to change the anesthetic method. Surgical time was similar to that conducted with other methods of anesthesia and there were no cases of adverse effects of local anesthetics. Intra-operative complications amounted to approximately 2.64%. There was no need for hospital admissions greater than 24 hours. Conclusion: The procedure is feasible and causes no perioperative significant pain, is safe, can be performed by residents under supervision, has satisfactory patient acceptance and complications similar to those observed in a conventional herniorrhaphy, allowing lower time and cost of hospitalization and faster access to treatment.

Keywords

Inguinal Hernia/Surgery, Local Anesthesia, Ambulatory Surgical Procedures

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Zavadinack Netto, M., Prado Filho, O.R., Bandeira, C.O.P., Sales, K.P.F. and Camiloti, T.A. (2000) Herniorrafia Inguinal: Anestesia Local ou Regional? Acta Scientiarum, 22, 621-623.
[2]	Ribeiro, F.A.S. (2009) Cirurgia Ambulatorial. In: Saad Junior, R., Salles, R.O.R., Carvalho, W.R. and Maia, A.M., Eds., Tratado de Cirurgia do CBC, Atheneu, São Paulo, 1467-1481.
[3]	Vater, J. and Gonçalves, M.C.V. (1987) Ampliação do binômio anestesia localpaciente externo: Enfoque especial para as hérnias inguinocrurais. Residência Médica (Rio de Janeiro), 15, 10, 13-14, 17-22.
[4]	Abdu, R.A. (1983) Ambulatory Herniorrhaphy under Local Anesthesia in a Community Hospital. The American Journal of Surgery, 145, 353-356. http://dx.doi.org/10.1016/0002-9610(83)90199-X
[5]	Amid, P.K., Shulman, A.G. and Lichtenstein, I.L. (1994) Local Anesthesia for Inguinal Hernia Repair Step-by-Step Procedure. Annals of Surgery, 220, 735-737. http://dx.doi.org/10.1097/00000658-199412000-00004
[6]	Skinovsky, J., Sigwalt, M.F., Bertinato, L.P., Chibata, M., Moreira, L.M.S. and Granzotto, P.C.D. (2006) Herniorrafia Inguinal Com Anestesia Locorregional—(uso de ropivacaína). Revista do Colégio Brasileiro de Cirurgiões, 33, 224-227. http://dx.doi.org/10.1590/S0100-69912006000400006
[7]	Lichtenstein, I.L. (1970) Hernia Repair without Disability. 1st Edition, Mosby, St. Louis.
[8]	Sakorafas, G.H., Halikias, I., Nissotakis, C., Kotsifopoulos, N., Stavrou, A., Antonopoulos, C. and Kassaras, G. (2001) Open Tension Free Repair of Inguinal Hernias; the Lichtenstein Technique. BMC Surgery, 1, 3. http://dx.doi.org/10.1186/1471-2482-1-3
[9]	Huskisson, E.C. (1974) Measurement of Pain. Lancet, 2, 1127-1131. http://dx.doi.org/10.1016/S0140-6736(74)90884-8
[10]	MEC [Internet]. (2009) Brasília: Ministério da Educação. http://www.mec.gov.br
[11]	Silva, D.N., Griebeler, M.L., Fernandes, S.F., Paixão, L.Q., Pitrez, F.A.B. (2004) Herniorrafia Ambulatorial Comparada a Convencional. Revista do Colégio Brasileiro de Cirurgiões, 31, 287-90. http://dx.doi.org/10.1590/S0100-69912004000500004
[12]	Laurino Neto, R.M., Buchmann, A.A.C.M. and Messias, L.R.R. (2004) Tratamento cirúrgico das hérnias inguinais sob anestesia local em ambulatório. Revista do Colégio Brasileiro de Cirurgiões, 31, 102-106. http://dx.doi.org/10.1590/S0100-69912004000200006
[13]	Castoro, C., Bertinato, L., Baccaglini, U., Drace, C.A. and McKee, M. with the Collaboration of IAAS Executive Committee Members (2007) Day Surgery: Making It Happen. World Health Organization, on Behalf of the European Observatory on Health Systems and Policies.
[14]	Executive Committee of International Association for Ambulatory Surgery (2003) Ambulatory (Day) Surgery—Suggested International Terminology and Definitions. Paris. http://www.iaas-med.com/joomla/images/stories/uploaded_files/IAAS_definitions.pdf http://www.iaas-med.com/joomla/index.php
[15]	Keyes, G.R., Singer, R., Iverson, R.E., McGuire, M., Yates, J., Gold, A., Reed, L., Pollack, H. and Thompson, D. (2008) Mortality in Outpatient Surgery. Plastic and Reconstructive Surgery, 122, 245-250. http://dx.doi.org/10.1097/PRS.0b013e31817747fd
[16]	Bay-Nielsen, M and Kehlet, H. (2008) Anaesthesia and Post-Operative Morbidity after Elective Groin Hernia Repair: A Nation-Wide Study. Acta Anaesthesiologica Scandinavica, 52, 169-174. http://dx.doi.org/10.1111/j.1399-6576.2007.01514.x
[17]	Barros, F., et al. (2008) Can We Find Predictive Factors for Unplanned Overnight Admission. Ambulatory Surgery Journal, 14.
[18]	Department of Health (2002) Day Surgery: Operational Guide. Department of Health Publications, London. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_ 4005487
[19]	Lemos, P., Regalado, A., Soares, J. and Alves, E. (2006) A evolução recente da cirurgia ambulatória em Portugal. Resultados do IV Inquérito Nacional. Revista Portuguesa de Cirurgia Ambulatória, 7, 5-15.