Ambulatory Inguinal Hernia Repair Research Articles

To compare the outcome of inguinal hernia repair under local and spinal anesthesia

INTRODUCTION: The most frequent form of hernia is inguinal hernia, affecting around 15% of adult males. The optimal surgical anesthetic method for ambulatory inguinal hernia repair is unknown at the moment, and there is no consensus on the procedure. The goal of this study was to examine the outcome of inguinal hernia repair under local anesthesia compared with spinal anesthesia. MATERIALS AND METHODS: In this prospective observational study, 80 patients were randomly assigned into two groups by the SNOSE method with a different mode of anesthesia: group SA (n = 40) and group LA (n = 40). Lichtenstein tension-free hernioplasty was done in all patients. Pre- and post-OP clinical examinations (3rd day) were looked for complications. RESULTS: There were no significant demographic differences between the two groups. When compared with the SA group, the LA group experienced much less post-operative pain. With local anesthesia, post-operative ambulation was substantially faster. The use of a local anesthetic allowed for a shorter stay in the hospital and a speedy return to regular activity. In general, local anesthesia was linked to less post-operative complications in the early aftermath. CONCLUSION: Local anesthesia is a preferable choice to spinal anesthesia for short stay or daycare surgery, particularly for patients who are unable to tolerate spinal anesthesia. As a result, Lichtenstein’s hernioplasty performed under local anesthesia is attracting considerable interests in the field of groin hernia repair.

Comparison of Analgesic Efficacy of Local Anesthetic Infiltration and Ultrasound-guided Abdominal Wall Nerve Block in Children Undergoing Ambulatory Inguinal Hernia Repair

PurposePlacement of local anesthetics either as infiltration (LAI) or as abdominal wall nerve block (AWNB) has been shown to reduce postoperative pain following laparoscopic surgery. We aimed to compare intraoperative remifentanil consumption and postoperative pain of AWNB and LAI in children undergoing ambulatory two-port laparoscopic inguinal hernia surgery with propofol-remifentanil based general anesthesia. DesignRandomized controlled trial. MethodsChildren aged between 1 and 6 years undergoing two-port laparoscopic inguinal hernia repair were enrolled for analysis. These children received one of the three anesthesia regimens (1) standard general anesthesia (SGA); (2) SGA with preemptive LAI; (3) SGA with preemptive AWNB; and were categorized accordingly. Primary outcome variable were intraoperative average infusion rate of remifentanil and postoperative FLACC (Face, Legs, Activity, Cry, and Consolability) pain score. Secondary outcome data included demographics, intraoperative variables (hemodynamics and bispectral index score recorded at three different time points), and duration of surgery. FindingsA total of 90 children (30 in each group) were included in the analysis. General information, intraoperative hemodynamic variables, bispectral index score, and duration of surgery were not significantly different among groups. The intragroup variation of hemodynamic variables were less stable in the SGA group compared with the other two groups, while BIS score was similar among groups. The intraoperative infusion rate of remifentanil was significantly lower in the AWNB group than in the SGA or the LAI group (median [25th to 75th centiles]: 0.11[0.11 to 0.11] µg/kg/min, 0.33[0.33 to 0.33] µg/kg/min; 0.17[0.17 to 0.20] µg/kg/min, respectively, P < .001 for both), and lower in the LAI group than in the SGA group (P < .001). The postoperative FLACC pain score was significantly lower in the AWNB group than in the SGA or the LAI group (P < .001 for both). ConclusionsAWNB is associated with a lower intraoperative remifentanil requirement and a lower postoperative FLACC pain score compared with LAI in children undergoing laparoscopic inguinal hernia repair with propofol-remifentanil based general anesthesia.

Selective spinal anesthesia with hyperbaric prilocaine provides better perioperative pain control than local anesthesia for ambulatory inguinal hernia repair without affecting discharging time: a randomized controlled trial

PurposeLocal anesthesia is the most used anesthetic technique for inguinal hernia repair, despite its unpredictability. Selective spinal anesthesia with a short-term local anesthetic guarantees rapid recovery, predictable duration and low incidence of side effects. We tried to assess the efficacy of this neuraxial technique in ambulatory setting.MethodsOne hundred thirty-two ASA I–III, aged > 18 patients scheduled for inguinal hernia repair have been randomized into two groups receiving unilateral spinal anesthesia with 40 mg of hyperbaric prilocaine (group A) or local anesthesia with mepivacaine (group B). Primary endpoint: intraoperative and post-operative NRS. Other outcomes: sensory block onset, need for opiates and deep sedation, surgery duration, and time to discharge.ResultsGroup A: intraoperative NRS was 0 in 100% of patients; post-operative maximum NRS was > 3 in 12.12% of patients. Group B: mean intraoperative NRS was 4; mean post-operative NRS was 2.5. Spinal anesthesia resulted superior in controlling both intraoperative and post-operative pain (p < 0.00001; p = 0.008). Mean time of the motor block resolution in group A was 98 ± 2 min. Mean time to discharge was not significantly different between groups. Surgical time was significantly different between the two groups (mean time of 37 ± 3.2 min group A; 54 ± 6 min group B—p < 0.00001).ConclusionSpinal anesthesia group patients had significantly less pain than local anesthesia group, both intraoperatively and post-operatively, without differences in time to discharge, incidence of complications and with improvement of surgical time. More randomized controlled trials are needed to confirm this hypothesis.Trial registrationNCT05136534. Registered November 29, 2021—Retrospectively registered

Paravertebral blocks reduce the risk of postoperative urinary retention in inguinal hernia repair.

Inguinal hernia repair and general anesthesia (GA) are known risk factors for urinary retention. Paravertebral blocks (PVBs) have been utilized to facilitate enhanced recovery after surgery. We evaluate the benefit of incorporating PVBs into our anesthetic technique in a large cohort of ambulatory patients undergoing inguinal hernia repair. Records of 619 adults scheduled for ambulatory inguinal hernia repair between 2010 and 2015 were reviewed and categorized based on anesthetic and surgical approach [GA and open (GAO), GA and laparoscopic (GAL), PVB and open (PVBO), and GA/PVB and open (GA/PVBO)]. Patients were excluded for missing data, self-catheterization, chronic opioid tolerance, and additional surgical procedures coinciding with hernia repair. Risk factors associated with the primary outcome of urinary retention were examined using logistic regression. PVBO (n = 136) had significantly lower odds than GAO of experiencing urinary retention (odds ratio 0.16; 95% CI 0.05-0.51); overall (P < .01), with 4.4% (n = 6) of the patients in the PVBO group having urinary retention versus 22.6% (n = 7) with GAO. Expressed as intravenous morphine equivalences, the PVBO group had the lowest median opioid use (5mg), followed by GA, PVB, and open (7.5mg); GAO 25mg; and GAL 25mg. Also, 30% (n = 41) of the PVBO group required no opioid analgesia in the postanesthesia care unit. PVBs as the primary anesthetic or an adjunct to GA is the preferred anesthetic technique for open inguinal hernia repair as it facilitates enhanced recovery after surgery by decreasing risk of urinary retention, opioid requirements, and length of stay.

Transient Femoral Nerve Palsy Following Ilioinguinal Nerve Block for Inguinal Hernioplasty.

Background:Elective inguinal hernia repair in young fit patients is preferably done under ilioinguinal nerve block anesthesia in the ambulatory setting to improve throughput, save cost, and increase patient satisfaction. A rare complication of ilioinguinal nerve block is transient femoral nerve palsy (TFNP).Objectives:The aim of this study is to examine the incidence of TFNP among adults undergoing ambulatory inguinal hernia repair under ilioinguinal nerve block.Patients and Methods:Patients 18 years and older in the American Society of Anesthetists classes I and II who underwent ambulatory inguinal hernia repair over a 3-year period under ilioinguinal nerve block only were assessed for evidence of TFNP. All patients had power on the ipsilateral limb checked 30 min before and 1 h after the procedure. TFNP was considered present if there was sensory loss over the anterior aspect of the thigh, weakness of extension at the knee joint, or reduction in power of the ipsilateral limb.Results:One hundred and twelve patients were involved in the study; 90 (80.3%) males and 22 (19.6%) females with the mean age of 45.7 years. All had normal power (Grade 5) in the ipsilateral limb before instituting the nerve block. Postoperatively, 3 (2.6%) patients had grade 4 and recovered normal power over a 2–6-h period and were subsequently discharged.Conclusion:TFNP is a rare complication of ilioinguinal nerve block which delays patient discharge postambulatory hernioplasty.

Low-dose Bupivacaine with Fentanyl for Spinal Anesthesia during Ambulatory Inguinal Hernia Repair Surgery: A Comparison between 7.5 and 10 mg of 0.5% Hyperbaric Bupivacaine—A Retrospective Study

Low-dose Bupivacaine with Fentanyl for Spinal Anesthesia during Ambulatory Inguinal Hernia Repair Surgery: A Comparison between 7.5 and 10 mg of 0.5% Hyperbaric Bupivacaine—A Retrospective Study

A Pain Education Intervention for Patients Undergoing Ambulatory Inguinal Hernia Repair: A Randomized Controlled Trial.

Background Inguinal hernia repair is a common ambulatory surgery after which many patients experience moderate to severe post-operative pain. Limited research has examined the effect of education interventions to reduce pain after ambulatory surgery. Purpose This trial evaluated the effectiveness of an individualized Hernia Repair Education Intervention (HREI) for patients following inguinal hernia repair. Method Pre-operatively, participants (N = 82) were randomized to either the intervention (HREI) or the usual care group. The HREI included written and verbal information regarding managing pain and two telephone support calls (before and after surgery). The primary outcome was WORST 24-h pain intensity on movement on post-operative day 2. Secondary outcomes included pain intensity at rest and movement, pain-related interference with activities, pain quality, analgesics consumed, and adverse effects at post-operative days 2 and 7. Results At day 2, the intervention group reported significantly lower scores across pain intensity outcomes, including WORST 24-h pain on movement and at rest (p < 0.001), and pain NOW on movement and at rest (p = 0.001). Conclusion These findings suggest that the HREI may improve patients' pain and function following ambulatory inguinal hernia repair. Further research should examine the effectiveness of an education intervention over a longer period of time.

Ultrasound-guided ilioinguinal/iliohypogastric block did not reduce emergence delirium after ambulatory pediatric inguinal hernia repair: a prospective randomized double-blind study.

Emergence delirium (ED) is a common postoperative complication of ambulatory pediatric surgery done under general anesthesia with sevoflurane. However, perioperative analgesic techniques have been shown to reduce sevoflurane-induced ED. The primary objective of this investigation was to examine whether an ultrasound-guided ilioinguinal/iliohypogastric (II/IH) nerve block for ambulatory pediatric inguinal hernia repair could reduce the incidence of sevoflurane-induced ED. The subjects of this prospective randomized double-blind study were 40 boys ranging in age from 1 to 6years, who were scheduled to undergo ambulatory inguinal hernia repair. The patients were randomized to either receive or not to receive an ultrasound-guided II/IH nerve block (Group B and Group NB, respectively). General anesthesia was maintained with sevoflurane and nitrous oxide. The primary outcome assessed was ED, evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) scale 30min after emergence from general anesthesia. The secondary outcomes assessed were postoperative pain, evaluated using the Behavioral Observational Pain Scale (BOPS), and the amount of intra-operative sevoflurane given. The median PAED scale scores did not differ between Groups B and NB at 30min (P=0.41). BOPS scores also did not differ significantly between the groups, but the mean amount of intraoperative sevoflurane given was significantly lower in Group B than in Group NB (P<0.01). Ultrasound-guided II/IH nerve block for ambulatory pediatric inguinal hernia repair did not reduce ED, but it did decrease the amount of intra-operative sevoflurane needed. UMIN000008586.

Pilot Study of Ambulatory Inguinal Hernia Repair under Ultrasound-guided Transversus Abdominis Plane Block Anesthesia Plus Conscious Sedation

Aim: Transversus abdominis plane (TAP) block is mainly used as part of multimodal postoperative analgesia regimens in a wide variety of abdominal operations. Our purpose was to evaluate feasibility and safety of TAP block as anesthesia method for inguinal hernia repair. Methodology: Twenty patients scheduled to undergo ambulatory inguinal hernia repair were selected and consented to ultrasound -guided TAP block anesthesia plus conscious sedation. Twenty to 25 ml of ropivacaine 0.5% were administered into the TAP and sensory blockade ofT11-L1 dermatomes was examined 30 minutes later. Data on

General anesthesia plus ilioinguinal nerve block versus spinal anesthesia for ambulatory inguinal herniorrhapy.

Objective:The aim was to evaluate general anesthesia (GA) plus ilioinguinal nerve block (IIB) versus spinal anesthesia (SA) in patients scheduled for ambulatory inguinal hernia repair regarding pain management, anesthesia recovery and reducing potential complications.Materials and Methods:A double-blind, prospective, randomized, controlled study in patients American Society of Anesthesiologists I-III randomized into two groups: GA plus IIB group, induction of anesthesia with propofol, maintenance with sevoflurane, airway management with laryngeal mask allowing spontaneous ventilation and ultrasound-guided IIB; SA group, patients who underwent spinal block with 2% mepivacaine. The study variables were pain intensity, assessed by visual analog scale, analgesic requirements until hospital discharge, time to ambulation and discharge, postoperative complications-related to both techniques and satisfaction experienced.Results:Thirty-two patients were enrolled; 16 patients in each group. The differences regarding pain were statistically significant at 2 h of admission (P < 0.001) and at discharge (P < 0.001) in favor of the GA plus ilioinguinal block group. In addition in this group, analgesic requirements were lower than SA group (P < 0.001), with times of ambulation and discharge significantly shorter. The SA group had a higher tendency to develop complications and less satisfaction.Conclusion:General anesthesia plus IIB is better than SA regarding postoperative analgesia, time to mobilization and discharge, side-effect profile and satisfaction experienced by the patients.

Local Versus Spinal Anesthesia in Lichtenstein Mesh Technique for Inguinal Hernia Repair in Ambulatory Patients: A Randomized Controlled Trial

Objective: This study aimed to determine whether Lichtenstein mesh Technique under local anesthesia results in better patient outcomes when compared with repair under spinal anesthesia. Methods: Patients &gt; 18 years old, with primary, unilateral inguinal hernia handled between January 2008 to July 2010, and who fulfilled the specific inclusion criteria were enrolled. They were randomly assigned to either local anesthesia (LA), or, the spinal anesthesia (SA) groups. Outcome variables monitored included: total operative time, postoperative pain from days 1-7, complications, number of analgesic doses, and, time interval from surgery to resumption of routine occupational and sexual activities. Results: There were 101 patients (98 males and 3 female) LA group included 54 patients (52.5%) while the SA group, 48 patients (47.5%). Patients in LA group are younger in age but this is of no statistical significance (P=0.07). Significant differences between the two groups included: presence of urinary retention and more postoperative analgesia required within the first 24 hours among SA patients. Overall, LA group had less postoperative pain, fewer complications, and faster recovery with early resumption of occupational and sexual activities. Conclusion: This study offers significant evidence to prove that local anesthesia is a safe, cost-effective and practical alternative to spinal anesthesia for fast-track ambulatory inguinal hernia repair. Key words: inguinal hernia, lichtenstein mesh repair, local anesthesia, spinal anesthesia

Ambulatory inguinal hernia repair with prolene hernia system (PHS)

Study was conducted to evaluate the feasibility and benefits of inguinal hernia repair with prolene hernia system (PHS) mesh under local anaesthesia as a day surgery procedure in a multinational society of United Arab Emirates. One hundred and seventy-eight inguinal hernias in 172 consecutive adults of whom 154 (89.5%) fitted the criteria of inclusion in the day-case surgery settings were operated upon including one early recurrence. Conversion from local to general anaesthesia was required in five (2.8%) patients. The mean operation time was 65 min, including the anaesthesia injection. The mean hospital stay was 2.1 days for all patients and 1.01 days for those who fitted in the ambulatory surgery program. Inguinal hernia repair using the PHS technique under local anaesthesia could be mastered by many of the surgeons in our hospital with minimal morbidity and short hospital stay with a potential to lessen recurrence.

Factors influencing patient disposition after ambulatory herniorrhaphy

Purpose: To determine factors associated with patient disposition status other than discharge to their customary residence (DCR) after elective, ambulatory inguinal hernia repair (IHR). Materials and methods: N = 7953 patients who underwent IHR were identified in the National Survey of Ambulatory Surgery (NSAS). Disposition status was examined by age, sex, race, type of anesthetic, anesthesia provider, expected source of payment, laterality of the procedure, facility type and US region. Logistic regression was used to examine independent risk factors for such disposition status. Results: Independent risk factors for disposition status other than DCR included anesthesia type, anesthesia provider, increasing age of the patient, and bi- versus unilaterality of the procedure. Differences in disposition status were also found by facility type and US region in which the procedure was performed. Discussion: The increased cost associated with a disposition status other than DCR requires identification of factors that independently contribute to such an outcome. In this study a number of anesthesia related and unrelated factors were identified that may impact on the disposition of patients undergoing ambulatory inguinal hernia repair. In light of limitations inherent to analysis of large databases our results should be interpreted with caution and prospective trials are needed for validation of our findings. The value of our results may lie particularly in the hypothesis generation for such trials.

Prospective Randomized Trial of Pre‐emptive Analgesics following ambulatory inguinal hernia repair: intravenous ketorolac versus diclofenac suppository

Prospective Randomized Trial of Pre‐emptive Analgesics following ambulatory inguinal hernia repair: intravenous ketorolac versus diclofenac suppository

Determinant factors of pain after ambulatory inguinal herniorrhaphy: a multi-variate analysis.

Pain is common after inguinal herniorrhaphy. The objective of our study was to evaluate the significance of various clinical factors on the level of post-operative pain after ambulatory inguinal herniorrhaphy. Between January, 1996 and December, 1998, 239 ambulatory inguinal hernia repair patients were recruited. Operative techniques included nylon darn (n = 152), modified Bassini repair (n = 56), and prolene mesh hernioplasty (n = 30). Linear analogue pain scores--ranging in value from 0 to 10--were assessed by telephone interviews on the first and third post-operative days. Uni-variate and multi-variate analyses were performed to identify the significant independent determinant factors affecting the severity of post-operative pain. Clinical factors studied were age, sex, operative technique, hernia anatomy and post-operative complication(s). By uni-variate analysis, patients of age < or = 50 years and indirect inguinal hernia were associated with a significantly higher pain score on the first postoperative day 1. On post-operative day 3, patients of age < or = 50 years, with an indirect inguinal hernia and modified Bassini repair reported a significantly higher pain score. Following inguinal herniorrhaphy, multiple regression analysis showed that age was the only independent predictive factor of pain score on post-operative days 1 and 3. In conclusion, post-operative pain was not affected by surgical technique, sex, hernia anatomy and post-operative morbidity. Only age had a significant influence on the post-operative pain score following ambulatory inguinal herniorrhaphy. Therefore, the age of a patient should be taken into consideration when prescribing post-operative analgesics.

Clinical factors influencing return to work after ambulatory inguinal herniorrhaphy in Hong Kong

Ambulatory inguinal hernia repair is the commonest day case general surgery operation. The present study was conducted to evaluate factors influencing the contemporary pattern of convalescence following ambulatory inguinal hernia repair in Hong Kong. A total of 271 consecutive ambulatory inguinal hernia repairs were performed at a day surgery centre from December 1995 to December 1998. The convalescent period prior to resuming work was analysed by multi-variate analysis with respect to significant clinical variables. A sick leave of 3 weeks was adequate for most patients following uncomplicated ambulatory inguinal hernia repairs. Factors associated with early return to work included age ≤50 years, indirect inguinal hernia and sedentary occupation. Occupation was the only independent factor affecting the duration of time off work on multi-variate analysis.

Patient satisfaction after ambulatory inguinal hernia repair in Hong Kong

Ambulatory surgery was introduced to Asia in the 1990s. Acceptance of ambulatory surgery by oriental patients remains largely unknown. A telephone survey was conducted to evaluate the level of patient satisfaction following ambulatory inguinal hernia repair. A total of 157 patients (61%) completed the telephone survey. More than 90% of the respondents expressed satisfaction with regard to the pre-operative, operative and post-operative service. The majority of the respondents (>80%) preferred to undergo day surgery again in case of hernia recurrence. Our findings prove that ambulatory surgery has a high level of acceptance in Chinese patients and supports the expansion of a day surgery service in Hong Kong.

Lichtenstein patch or Perfix plug-and-patch in inguinal hernia: A prospective double-blind randomized controlled trial of short-term outcome

Background: Open mesh used in anterior inguinal hernia repair can be configured as a flat patch (Lichtenstein operation) or as a cone-shaped preformed plug and supplementary patch (plug-and-patch operation; Perfix Plug; Davol Inc, Cranston, RI). Methods: One hundred forty-one patients were randomly allocated and blinded to receive either a Lichtenstein patch or a Perfix plug-and-patch. Information before the operation and on postoperative days 3 and 14 was recorded by an independent blinded observer to include operating time, postoperative pain, analgesic medication, return to activity and work, and quality of life assessment. Results: Operating time (32 vs 37.6 minutes) was significantly shorter in the plug-and-patch group (P =.01). During days 1 through 8, atients who had undergone the plug-and-patch operation experienced less pain, and their physical functioning on day 3 was significantly better (P =.013). Days of analgesic medication (4.0 vs 4.6 days), return to normal activity (2.8 vs 3.6 days), return to work (17.0 vs 20.8 days), and total days of work missed (14.3 vs 16.1 days) were similar in both groups (P = NS for all comparisons). Conclusions: Compared with patients who received the Lichtenstein patch for ambulatory inguinal hernia repair, patients who underwent the Perfix plug-and-patch operation experienced less postoperative pain in the first 8 days after the operation but consumed similar postoperative analgesic medication. The rate of return to normal activity and work is similar in both groups, which indicates no superiority for the plug-and-patch operation in overall rehabilitation and societal costs. Overall hospital costs are greater for the plug-and-patch operation ($120 [US]) compared with the Lichtenstein patch ($20 [US]), with a negligible (5.6 minutes) saving of operating room time for the plug-and-patch operation. (Surgery 2000;127:276-83.)

Ambulatory inguinal hernia repair compared with short-stay surgery

Two groups of patients operated on for inguinal hernia, one outpatient group and one inpatient group, are compared with respect to subjective distress and immediate postoperative complications. The groups were chosen at random and matched for sex and age. A large number of those who received treatment as outpatients suffered marked distress during the first postoperative days. Some form of intermediary or light nursing should be tried out for the outpatients so that if necessary they can stay the night after operation at the hospital. The number of postoperative complications was equal in the two groups. With suitable patient selection and with a small number of reserve places in a light-care ward, the majority of inguinal hernia operations can be performed on outpatients, resulting in a considerable economic saving and shorter waiting time.