"One step procedure" local anaesthesia for inguinal hernia repair in ambulatory surgery conditions--district general hospital experience

Abstract

Ambulatory surgery refers to hospitalization that does not exceed 24 hours, during which a surgical procedure is performed. Inguinal hernia repairs done under local anaesthesia on an outpatient basis are no longer performed exclusively in specialized hernia centers. They are becoming widely accepted by surgeons working in district hospitals, which was significantly contributed to by the publication of the EHS Guidelines on the Treatment of Inguinal Hernia.

Objective: The objective of this retrospective study is to show local anaesthesia practicability for inguinal hernia repairs through "one -step procedure", being a one-day procedure used in District General Hospital.

Methods: From January 2006 to June 2011, 460 elective surgery procedures were performed on 428 patients with inguinal hernia (396 with unilateral and 32 with bilateral inguinal hernia), using Lichtenstein technique, UHS/PHS, plug repair, and Shouldice technique. All the proceduress were performed under local anaesthesia by the same surgeon using "one-step procedure" in ambulatory surgery. The following anaesthetics were used: Lidocaine for intradermal and subcutaneous anaesthesia as well as Bupivacaine/Levobupivacaine for subfascial anaesthesia.

Results: From January 2006 to June 2011, 460 surgical procedures were performed on 428 patients with inguinal hernia (396 with unilateral and 32 with bilateral inguinal hernia). The mean age was 58.2 yrs (20-84). All the patients were in the ASA I-III group. In unilateral hernias, the mean operating time using Lichtenstein technique was 38mins (28-56), using PHS/UHS 28mins (22-40), with plug 33mins (27-39) and using Shouldice technique 43mins (32-53). In bilateral hernias, the mean operating time using Lichtenstein technique was 71mis (56-87), and using PHS /UHS 56mins (49-64). The mean hospital stay was 2.9hrs (2-6). The mean distance of residence from the hospital was 23km (1-150). During the course of the surgery, 15 patients (3.5%) had problems such as pain, bradycardia, hypotension, or perspiration. The complications during the mean follow-up of 31 months (1-60) was: 1.4% (6 patients)--a hematoma, 1.87% (8 patients)--seroma, 0.47% (2 patients)--wound infection, 0.23% (1 patient)--chronic pain, and 0.47% (2 patients)--recurrence. Revision due to active bleeding was conducted in two patients (0.47%), after using PHS and Lichtenstein techniques. These were the only patients who were rehospitalized due to complications.

Conclusion: In hernia repairs on an outpatient basis, "one-step procedure" in local anaesthetic administration is reliable, easy, safe, effective, and the type of the surgical technique is not a determining factor. The success rate and treatment outcome depend on the surgical technique and the surgeon's experience in using local anaesthesia in ambulatory surgery.