Inguinal Hernia Repair with Progrip ™ Mesh Under Local Anesthesia in High-Risk Elderly Patients

Abstract

Background: Inguinal hernia repair surgery is one of the most common surgical procedures in the world. There are various types of this surgery, and emerging evidence suggests repair under local anesthesia using Parietex ProGrip mesh may be a favorable option for individuals who are elderly and high-risk. This study aimed to explore its reliability and efficacy in that demographic.Materials and Methods: The results of 160 patients who underwent inguinal hernia surgery using Parietex ProGrip mesh between January 2014 and March 2018 were retrospectively reviewed. Local anesthesia was administered by anesthesiology expert with using a mixture of 20 mg/ml lidocaine + 0.0125 mg / mL epinephrine, 2% prilocaine, 0.5% bupivacaine and saline. Preoperative ultrasonography was performed to assess the type of inguinal hernia, and Gilbert was the preferred classification method. The operative and mesh application times, postoperative recurrence of hernia and health status, along with follow-ups were statistically evaluated.Results: In the present study, 160 patients had a mean ± standard deviation (SD) age of 73.6 ± 3.4 y. Most were diagnosed with Gilbert type 2 (n = 42; 26.3%) and type 3 (n = 49; 30.6%) inguinal hernias; all were ASA Grade 3 (n = 83; 51.9%) or Grade 4 (n = 77; 48.1%). The mean ± SD operative and mesh application times were 30.0 ± 3.8 min and 1.18 ± 0.6 min, respectively. No anesthesia-related side effects or treatment-related mortalities were observed. No readmission, systemic complication, postoperative recurrence or death occurred during the 6-month follow-up period. Postoperative seroma was observed in 6 patients and confirmed by a radiologist via ultrasonography. The pain visual analog scale (VAS) score decreased significantly and the health VAS score increased significantly over time (p=0.0001 for both).Conclusions: Open inguinal hernia surgery performed using a self-adhesive Parietex ProGrip mesh under local anesthesia is a safe and effective treatment option for high-risk elderly patients.