Utilizing local anesthesia and monitored anesthesia care sedation in open inguinal hernia repair in complex, comorbid patients.

Abstract

<h4>Introduction</h4>With the advancement of modern surgical technology, the interest in minimally invasive techniques for inguinal hernia repair has grown exponentially with open inguinal hernia repair becoming somewhat passé. However, patients, especially those with comorbidities, can avoid general anesthesia with open inguinal hernia repair. This study evaluated outcomes in patients undergoing open inguinal hernia repair under local anesthesia with sedation.<h4>Methods</h4>A prospectively maintained institutional database was queried for open inguinal hernia repair under local anesthesia with sedation. Patient demographics, operative details, and outcomes were analyzed descriptively. Intraoperatively, with the patient supine and prepared, a field block with a combination of 0.25% bupivacaine (Marcaine) with epinephrine and 1% lidocaine was performed before a modified Lichtenstein repair.<h4>Results</h4>Open inguinal hernia repair was performed in 164 patients with a mean age of 71.1 ± 14.0 years. Mean body mass index was 24.7 ± 3.7 kg/m², mean number of comorbidities was 3.3 ± 2.5, 15.2% of patients had diabetes, 37.8% had a history of smoking, 45.7% were American Society of Anesthesiologists III, 17.1% were American Society of Anesthesiologists IV/V, and 22.0% had recurrent hernias. All patients received synthetic mesh. Unilateral repair was performed in the majority of patients (98.8%). No patient required a general anesthetic. Total mean operative time was 75.4 ± 29.9 minutes. Mean operating room charge was $6149.1 ± $3413.5. Postoperatively, 1.8% of patients had wound cellulitis, 0.6% of patients developed a seroma requiring aspiration, and 3.7% experienced urinary retention. There were no recurrences with a mean follow-up of 17.8 ± 26.7 months.<h4>Conclusion</h4>Open inguinal hernia repair under local anesthesia with sedation is an effective, safe approach to manage inguinal hernias with limited cost, complications, and recurrences with 1.5 years of follow-up. This technique may benefit patients with comorbidities or patients who choose to avoid general anesthesia.