Local anesthesia for open mesh repair of recurrences after previous total extraperitoneal inguinal hernia repair

Abstract

INTRODUCTION: Optimum treatment for recurrences after laparoscopic repair of inguinal hernia (IH) is debatable. Guidelines recommend open repair under general anesthesia (GA), whereas emerging studies show relaparoscopy as a feasible option. Both require GA and incur extra cost. Does open surgery under local anesthesia (LA) is an option for recurrent hernia following laparoscopic surgery? METHODS: This is a retrospective review of medical reports of four patients who underwent open mesh repair under LA for recurrences after previous laparoscopic IH repair between May 2015 and August 2018. RESULTS: All the patients were male with a mean age of 50 years and 3 months (range 36–64 years). All the patients have primarily underwent total extraperitoneal (TEP) repair. Inadequate deperitonealization at the deep ring (n = 2), mesh migration (n = 1), and missed indirect sac were the causes for recurrences. All the patients underwent tension-free Lichtenstein repair under LA. The mean operative time was 25 min (range, 18–32 min). Tissue planes were well preserved and separation of cord structures from hernia sac and preservation of ilioinguinal nerve were possible in all cases. No conversions to GA. None of the patients had long-term morbidity or recurrences during the mean follow-up period of 1 year and 7 months (range, 1 month–2 years). All the cases were performed as day-case procedures. CONCLUSION: Open mesh repair under LA is a safe and effective option for recurrences after previous TEP repair of IH.