Tolerability of Incisional Hernia Repair Under Local Anesthesia. A Comparative Study

Abstract

Introduction: Surgery under local anesthesia, a gold standard for many abdominal wall hernia, was already used for incisional hernia surgery. There are no available studies about the tolerability of this method so far. Aim of this work is to check perioperative tolerability of incisional hernia repair under local anesthesia, comparing it with local anesthesia for inguinal hernioplasty. Methods: Between 2008 and 2018 we compared tolerability of local anesthesia in 100 patients undergoing incisional hernia repair (Group A) and 100 randomized patients receiving groin hernioplasty (Group B). Selection criteria for incisional hernia patients were size of hernia defects (<10 cm), absence of obstructive symptoms, hernia reducibility. We registered referred intraoperative pain (using Visual Analogue (VAS) score: range 0-10), local anesthesia needed in ml (m.v.) for 3 solutions (A, B, C), use of intraoperative sedation, intraoperative cardiovascular alterations, early ambulation, and discharge time. Statistical comparison was made with Mann-Whitney test. Results: In Gr.A 82 patients reported no pain, 17 reported mild pain and 1 reported moderate pain vs Gr.B respectively: 51, 41 and 8. For local anesthesia solutions volume(A,B,C): in Gr.A (19.96, 44.18, 5.54 ml) vs Gr.B (19.43, 53.47, 5.72) (p>0.01, p < 0.001, p>0.5). No differences in intraoperative sedation needs or cardiovascular alterations. Conversion necessity to general anesthesia was Gr.A 2/100 vs Gr.B 0/100 (p>0.05). Postoperative early ambulation and discharge in day surgery Gr.A vs Gr.B (98/98 vs 100/100, p>0.05). Conclusion: No differences in perioperative tolerability were found between Groups. Less pain was referred in Gr.A. Local anesthesia could be proposed routinely for incisional hernia repair.