[Inguinal hernia repair with local anesthesia--a comparative analysis]

Complications, Pain Control, and Patient Recovery After Local Versus General Anesthesia for Open Inguinal Hernia Repair in Adults—Systematic Review and Meta-analysis

The purpose of this systematic review is to provide an “up-to-date” evidence-based guideline and clarify the possible benefits as well as drawbacks of local anesthesia (LA) and general anesthesia (GA) in open inguinal hernia surgery in adults. Study method comprised randomized controlled trials. Primary outcome measures were complications, pain control, and patient recovery. Secondary outcome measures were patient satisfaction and hernia recurrence. A total of 14 randomized controlled trials contributed to the study. A total of 1677 patients were analyzed, with 953 in the LA group and 724 in the GA group. Complications were statistically less frequent in the LA group compared with the GA group [odds ratio (OR), 0.31; 95% confidence interval (95% CI), 0.15, 0.64). Supplemental intraoperative analgesia had a statistical significance in the LA group, with an OR of 28.93 (95% CI, 7.86, 106.47). Postoperative pain was statistically significantly lower in the LA group [standardized eman difference (SMD), −1.06; 95% CI, −1.64, −0.48)]. Length of stay was shorter for patients who underwent operation under LA compared with those receiving GA (OR, −1.21; 95% CI, −2.08, −0.33]). Time to full mobility was shorter in the LA group, without statistical significance (OR, 3.04; 95% CI, 0.19, 47.90), whereas measuring in SMD showed significance in comparison with GA (SMD, −1.74; 95% CI, −2.34, −1.14). Hernia recurrence was not noted. Patient satisfaction was greater in the LA group (SMD, 0.65; 95% CI, 0.15, 1.15). Compared with GA, LA showed superiority in terms of complications, postoperative pain, length of stay, time to full mobility, and patient satisfaction. Therefore, it appears to be a more appropriate anesthetic technique for open inguinal hernia repair in adults.

[Surgery of inguinal hernia as ambulatory and brief inpatient surgery]

Ambulatory surgery of inguinal hernia is gaining in popularity. While in the USA, admitting patients for inguinal hernia surgery is an exception, fewer than 10% of all such operations in Germany are performed in a day-case surgical setting. One reason for the situation observed in Germany is still a lack of acceptance by the patients. A second reason is the general nature of our health system. Surgery of the inguinal hernia can adequately be done as a standardised ambulatory procedure. We prefer conventional repair under local anaesthesia. In qualified hands, vitally dangerous complications are minimal. Careful indication, standardisation of the procedure as well as good information for and guidance of the patients provide a basis for successful day-case surgery. Indications, limitations, and risks are presented and analysed from a clinical point of view.