Elective Open Inguinal Hernia Repair Research Articles

Nerve identification during open inguinal hernia repair: a systematic review and meta-analyses

PurposeInguinal hernia repair is one of the most common operations worldwide and despite this, the incidence of chronic pain remains high after inguinal hernia repair. The optimal nerve handling strategy is controversial and the rate at which nerves are identified remains uncertain. This study aimed to determine the identification rates of the ilioinguinal, iliohypogastric, and genitofemoral nerves as well as nerve handling strategies.MethodsThis review was registered on PROSPERO (CRD 42023416576). PubMed, Embase, and Cochrane Central were systematically searched. Studies with more than 10 patients were included if they reported an identification rate for at least one of the nerves during elective open inguinal hernia repair in adults. Studies requiring nerve identification in their study design were excluded. Bias was assessed with the JBI critical appraisal tool and Cochrane’s RoB-2 tool. The overall estimate of the prevalence was analysed with prevalence meta-analyses.ResultsA total of 22 studies were included. The meta-analyses included 18 studies, which resulted in an identification rate of 82% (95% CI: 76–87%) for the ilioinguinal nerve, 62% (95% CI: 54–71%) for the iliohypogastric nerve, and 41% (95% CI: 27–55%) for the genitofemoral nerve. Nerves were spared in 82% of all repairs.ConclusionThe ilioinguinal, iliohypogastric, and genitofemoral nerves were identified in 82%, 62%, and 41% of surgeries, respectively. Most studies used a nerve-preserving strategy. The role of nerve identification in the development of chronic pain remains uncertain, as well as the optimal nerve handling strategy.

Efficacy of landmark based blind transverse abdominis plane block for post-operative pain relief in inguinal hernia

Background: Pain after open hernia surgery can be moderate-to-severe and is known to be associated with prolonged hospital stay and delayed return to normal daily activities. Aims and Objectives: We aimed to investigate the effect of a blind landmark-based approach of transversus abdominis plane (TAP) block on patients undergoing elective inguinal hernia repair surgery under spinal anesthesia. Materials and Methods: This was a prospective, randomized, controlled, and clinical trial consisting of 60 patients scheduled for inguinal hernia repair under spinal anesthesia. Patients in Group-1 received TAP block by landmark based blind technique, whereas those in Group-2 did not receive TAP block. Pain assessments were scored for all patients at rest and movement at 2, 4, 6, 12, and 24 h after surgery using visual analog scale. Results: The pain scores in the post-operative period, during rest and movement, were significantly lower in patients that received TAP block. Significant number of cases reported nausea and vomiting or headache in Group-2 due to increase requirement of analgesics for pain relief during first the 24 h of post-operative period. Conclusion: Landmark-based blind TAP block may be an effective way of providing analgesia in patients undergoing elective open inguinal hernia repair under spinal anesthesia.

P-056 ELECTIVE OPEN INGUINAL HERNIA REPAIRS- ARE WE DISCLOSING ALL THE RISKS?

Abstract Introduction and Aim Elective open inguinal hernia repairs are one of the most common procedures carried out in the NHS with over 78000 operations per year. There are many risks associated with this procedure and so obtaining informed consent is imperative to patient care and patient choice. The aim of this study is to compare the quality of consent forms for elective open inguinal hernia repairs to the guidance provided by the Royal College of Surgeons (RCS) and the British Hernia Society (BHS). Method 60 patients (50 male, 10 female) undergoing elective open inguinal hernia repair between 01/09/2021–20/12/2021 were identified retrospectively. Their consent forms were audited against modified guidelines from RCS and BHS. The grade of the consenting surgeon was also noted. Results Sepsis (95%), recurrence (85%), and chronic pain (82%) were the most consented risks. Least consented serious risks were persistent numbness (47%), nerve injury (47%), and mesh infection (40%). Notable disparities existed between rates of consent and grade of surgeon: 64% of registrars consented for nerve injury compared to 9% of SHOs and 82% of SHOs consented for haematoma compared to 20% of consultants. Conclusion Serious risks such mesh infection and nerve injury were often missed from consent forms. There is inconsistency in consented risks between different grades of surgeon. A standardised consent form would improve consent consistency and potentially reduce rate of litigation for doctors and the trust. Comprehensive pre-made consent forms were therefore designed to better facilitate a standardised approach to the consenting process.

352 Improving Consent for Elective Inguinal Hernia Repair

Abstract Introduction Litigation costs the NHS billions each year. To avoid litigation against known risks of elective surgery it is important that proper consent it obtained. The initial aim was to establish the percentage of patients consented fully for inguinal hernia repair at Warrington and Halton teaching hospitals, a moderately sized district general hospital. The Trust uses the information produced by EDIO as their standard of informed consent. One of the main outcomes was the rate of consent for risk of chronic pain as this is the 3rd most commonly litigated complication and an identified risk of inguinal hernia repair. Method A retrospective audit looking at consent forms for adult men who underwent elective open inguinal hernia repair, over a 6-month period in 2019, was undertaken. After the first audit the results were discussed at the local audit meeting and teaching was given for what should be included on a consent form for inguinal hernia repair. A second cycle of the audit was run in 2021, after the COVID pandemic, to assess if consenting had improved. Results 66 vs 22 cases met the inclusion criteria for the first and second 6-month periods respectively. An improvement in consent for chronic pain was observed with 91% of patients in the second cycle being consented for chronic pain vs 79% in the first cycle. In the second cycle 32% of patients were also consented for the risk of “COVID”. Conclusions Teaching proper consent works effectively to improve consenting.

Ultrasound-guided transverse abdominis plane block, ilioinguinal/iliohypogastric nerve block, and quadratus lumborum block for elective open inguinal hernia repair in children: a randomized controlled trial

Background and objectivesUltrasound-guided ilioinguinal/iliohypogastric (II/IH) nerve blocks and transverse abdominis plane (TAP) blocks are widely used for postoperative analgesia in children undergoing inguinal hernia repair (IHR). Quadratus lumborum block (QLB)...

Can the preemptive use of lornoxicam or paracetamol prevent pain after inguinal hernia repair? A randomized prospective double-blind placebo controlled trial

INTRODUCTION: Nonsteroidal anti-inflammatory drugs have become a popular part of multimodal analgesic regimens particularly in ambulatory surgery. This study was designed to search the efficacy of preoperative administration of lornoxicam or paracetamol in patients who underwent open inguinal hernia repair. MATERIALS AND METHODS: American Society of Anesthesiologists Classification (ASA) I–III male patients with unilateral primary inguinal hernia scheduled for elective prosthetic repair under general anesthesia were randomly assigned to three groups. Group I patients were infused 100-ml normal saline 30 min before anesthesia (placebo), whereas Group II and Group III patients were given 8 mg lornoxicam or 1,000 mg paracetamol intravenously in 100-ml normal saline. Postoperative pain was treated with patient controlled intravenous morphine. Postoperative pain scores were evaluated with visual analog scale (VAS) in the recovery room and at 1st, 6th, 12th, and 24th hours postoperatively in all groups. Total amount of analgesics. Liker scale and SF-36 form was also used at 4th week follow-up in order assess quality of life. RESULTS: Totally 88 patients were completed the study (G1 = 28, G2 = 30, and G3 = 30). Preemptive use of both lornoxicam and paracetamol resulted in significantly lower recovery room VAS scores in comparison with placebo group (3.93, 3.73, and 5.25). Both lornoxicam and paracetamol groups (G2 and G3) displayed better results at 12th h than placebo group (P = 0.04). VAS scores at 24th hour were similar in three groups. Total morphine consumptions were also similar between the groups at all times. Total postoperative 1-week oral analgesic use was significantly less in G2 (lornoxicam), and G3 (paracetamol) in comparison with G1 (placebo). Quality of life indicators in Likert Scale and SF-36 form were also not different. CONCLUSION: Preemptive use of both lornoxicam and paracetamol may be effective in early postoperative pain control in patients undergo elective open inguinal hernia repair. However, there seems to be no difference between the efficacies of the two agents.

O41 PREDICTORS OF LOW QUALITY AFTER OPEN INGUINAL HERNIA REPAIR USING THE EURAHS-QOL SCORE: PROSPECTIVE MULTICENTRIC COHORT STUDY

Abstract Aim Evidence about factors influencing quality of life after inguinal hernia surgery is scarce. This study aimed to identify predictors of low Quality of Life (QoL) after open inguinal hernia repair, to guide practice and inform patients at high risk. Material and Methods Prospective multicentric cohort study including consecutive patients undergoing elective open inguinal hernia repair in Portuguese hospitals (October-December 2019). The primary outcome was Quality of Life at 3 months after surgery, using the EuraHS-QoL score (higher score correlates with lower QoL). Low QoL was defined as the higher EuraHS-QoL score tertile and multivariate logistic regression was used to identify predictors. Results 893 patients were included from 33 hospitals. The majority were men (89.9% [800/891]), had unilateral hernias 88.7% (774/872) and the most common surgical technique was Lichtenstein’s repair (52.9% [472/893]). The median QoL score was 24 (IQR 10-40) before surgery and 2 (IQR 0-10) at 3 months after surgery, showing significant improvement (p < 0.001). After adjustment, low QoL at 3 months was associated with low preoperative QoL (OR 1.76, 95% CI 1.21-2.57, p = 0.003), non-absorbable mesh fixation (OR 1.64, 95% CI 1.12-2.41, p = 0.011), severe immediate postoperative pain (OR 2.90, 95% CI 1.66-5.11, p < 0.001) and minor postoperative complications (OR 2.23, 95% CI 1.30-3.84, p = 0.004). Conclusions This study supports the use of the EuraHS-QoL score preoperatively to inform consent. Although significant improvement in QoL is expected after surgery, high scores before surgery are associated with low postoperative QoL. Caution should be taken with non-absorbable mesh fixation and immediate postoperative pain control should be optimised.

Predictors of low quality of life after open inguinal hernia repair using the EuraHS-QoL score: prospective multicentric cohort study across 33 hospitals.

Evidence about factors influencing quality of life after inguinal hernia surgery is scarce. This study aimed to assess patient's Quality of Life (QoL) after open inguinal hernia repair and to identify predictors of low QoL at 3 months after surgery, to guide practice and inform patients at high risk. Prospective multicentric cohort study including consecutive patients undergoing elective open inguinal hernia repair in Portuguese hospitals (October-December 2019). The primary outcome was Quality of Life at 3months after surgery, using the EuraHS-QoL score (higher score correlates with lower QoL). Low QoL was defined as the higher EuraHS-QoL score tertile and multivariate logistic regression was used to identify predictors. 893 patients were included from 33 hospitals. The majority were men [89.9% (800/891)], had unilateral hernias 88.7% (774/872) and the most common surgical technique was Lichtenstein's repair [52.9% (472/893)]. The median QoL score was 24 (IQR 10-40) before surgery and 2 (IQR 0-10) at 3months after surgery, showing significant improvement (p < 0.001). After adjustment, low QoL at 3months was associated with low preoperative QoL (OR 1.76, 95% CI 1.21-2.57, p = 0.003), non-absorbable mesh fixation (OR 1.64, 95% CI 1.12-2.41, p = 0.011), severe immediate postoperative pain (OR 2.90, 95% CI 1.66-5.11, p < 0.001) and minor postoperative complications (OR 2.23, 95% CI 1.30-3.84, p = 0.004). This study supports the use of the EuraHS-QoL score preoperatively to inform consent. Although significant improvement in QoL is expected after surgery, high scores before surgery are associated with low postoperative QoL. Caution should be taken with non-absorbable mesh fixation and immediate postoperative pain control should be optimised.

Comparison between Glucose Containing Solution D2.5% and Ringer Lactate as a Maintenance Fluid Management in Infants Undergoing Inguinal Hernia Repair

Abstract Background Infants and neonates are at particular risk of hypoglycemia when suffering from sepsis, asphyxia and hypothermia. A prospective study showed that up to 20% of preterm infants who were ready for discharge were still at risk of hypoglycemia when a feed was delayed. In contrast, surgery and critical illness may cause hyperglycemia. Objectives The aim of this study is to Assessment of glucose containing solutions 2.5 % as a maintenance fluid management intra operative in infants undergoing hernia repair as regard hyperglycemia and hypoglycemia. Patients and Methods The study was conducted on 100 randomly chosen patients aged from 28 days to 1 year, American Society of Anesthesiologists (ASA) class I scheduled for elective open inguinal hernia repair in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 50 patients each: Ringer lactate Group: patients received ringer lactate as maintenance fluid therapy according to body weight, glucose containing solution: patients received glucose containing solution 2.5% as maintenance fluid therapy according to body weight. Results The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia . Conclusion The usage of glucose containing solution 2.5% remained controversial, in this study we compared glucose 2.5 % in normal saline 0,9 % to ringer lactate and the results didn’t put a final decision to the usage of glucose containing solutions as The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia.

Comparison of Ultrasound-Guided Transversus Abdominis Plane Block with Sub-Arachnoid Block for Open Inguinal Hernia Repair.

Background:Open inguinal hernia repair is one of the routine day-care procedures performed across the world. A multitude of anesthetic techniques have been outlined for painless inguinal hernia repair, comprising general anesthesia and regional anesthesia such as spinal, epidural, and nerve blocks; with regional anesthetic techniques often favored for uncomplicated open inguinal hernia repair. Ultrasound-guided peripheral nerve blocks have made rapid strides and are gaining popularity because of the reduced incidence of adverse events.Aims:We aim to compare the efficacy of two regional anesthesia techniques to compare the adequacy of surgical anesthesia and their efficacy to ease postoperative pain with least potential side effects.Settings and Design:This prospective, interventional, single-centric, double-blind, randomized, parallel-group, active-controlled, Helsinki protocol-compliant clinical study was registered with the Clinical Trial Registry of India (CTRI/2021/04/033109). It was conducted after obtaining written informed consent from all patients and approval from the institutional review board.Materials and Methods:Sixty patients of American Society of Anesthesiologists physical status classes I/II, in the age group of 18–60 years of either sex, scheduled for elective open inguinal hernia repair, were enrolled into two groups of 30 patients each according to the anesthetic technique used. Group T comprised patients receiving ultrasound-guided transversus abdominis plane block (TAP block), whereas the Group S comprised patients administered spinal anesthesia for elective open inguinal hernia repair. The primary end points of this study were to assess the adequacy of surgical anesthesia and duration of postoperative analgesia, whereas the secondary end points included assessment of patients’ hemodynamic profile post institution of the block and comparing the incidence of adverse events associated with the two techniques.Statistical Analysis:SPSS version 20.0 was used for analysis. Frequency, mean distribution, standard deviation, Chi Square test and student t Test were calculated to p value. P < 0.05 was considered statistically significant. Continuous variables were expressed as mean + SD, whereas categorical variables were expressed as absolute numbers and percentages. Intergroup nominal categorical data were compared by Chi-square test.Results:The visual analog scale score was found significantly lower in Group T at all time points except immediate postsurgery (3, 6, 12, 24, and 48 h) as compared to Group S (0.357 ± 0.4880 vs. 1.393 ± 1.8527; P = 0.006, 1.393 ± 0.4973 vs. 2.893 ± 2.3148; P = 0.001, 2.429 ± 0.9201 vs. 3.321 ± 2.0377; P = 0.039, 1.214 ± 0.4179 vs. 2.286 ± 1.9217; P = 0.006, and 1.143 ± 0.3563 vs. 1.643 ± 1.5685; P = 0.106, respectively), and the duration of postoperative analgesia was highly significant (P < 0.001) in Group T (724.00 ± 103.2914 min) as compared to Group S (256.643 ± 73.4218 min). Difference in the number of rescue analgesics administered over the first 24 and 24–48 h was significantly higher in the spinal group which comprised patients administered with the TAP block.Conclusion:Ultrasound-guided TAP block provides better intra-operative and postoperative analgesia as compared to subarachnoid block especially in respiratory and cardiovascular cripples without any significant adverse events and hemodynamic changes.

USA Department of Defense audit of surgical antibiotic prophylaxis prescribing patterns in inguinal hernia repair.

Antibiotic prophylaxis in inguinal hernia repair (IHR) is contentious in literature and practice. In low-risk patients, for whom evidence suggests antibiotic prophylaxis is unnecessary, many surgeons still advocate for its routine use. This study surveys prescription patterns of Department of Defense (DoD) general surgeons. An anonymous survey was sent electronically to approximately 350 DoD general surgeons. The survey asked multiple-choice and free text answers about prescribing patterns and knowledge of current evidence for low-risk patients undergoing elective open inguinal hernia repair without mesh (OIHRWOM), open inguinal hernia repair with mesh (OIHRWM), or laparoscopic inguinal hernia repair (LIHR). 110 DoD general surgeons consented to participate. 58.6, 95 and 84.2% of surgeons always administer antibiotic prophylaxis in OIHRWOM, OIHRWM, and LIHR, respectively. 37.9, 70.9, and 63.2% of surgeons believe that it reduces rates of surgical site infection in OIHRWOM, OIHRWM, and LIHR, respectively. The most common reasons for empirically prescribing antibiotic prophylaxis include "I think the evidence supports it" (27 of 72 responses), "I would rather be conservative and safe" (15 of 72 responses), and "I am following my hospital/department guidelines" (9 of 72 responses). 11.8, 40.8, and 32.9% of surgeons believe current evidence supports antibiotic prophylaxis use in OIHRWM, OIHRWOM, and LIHR, respectively. 50, 18.4, and 22.4% of surgeons believe current evidence refutes antibiotic prophylaxis use in OIHRWM, OIHRWOM, and LIHR, respectively. The survey results indicate that the majority of practicing DoD general surgeons still empirically prescribe surgical antibiotic prophylaxis in IHR despite more conflicting opinions that it has no meaningful effect or that current evidence does not supports its use.

The effect of ultrasound-guided transversus abdominis plane (TAP) block on postoperative analgesia and neuroendocrine stress response in pediatric patients undergoing elective open inguinal hernia repair.

Transversus abdominis plane block (TAP) is a compartmental block of the anterior abdominal wall. Surgical trauma produces multisystem reactions. Anesthetic techniques can modify the neuroendocrine surgical stress response. The aim of this study was to evaluate the effect of TAP block on the modification of the surgical neuroendocrine stress response as well as its analgesia effect in children undergoing open inguinal hernia repair. Sixty children aged 3-10 years undergoing elective unilateral open inguinal hernia repair were randomized into group I (general anesthesia) or group II (received TAP block after induction of general anesthesia). Serum cortisol, blood glucose, quality of analgesia, postoperative need for rescue analgesia, and complications and degree of satisfaction of the patients and their parents were assessed. Serum cortisol level was significantly lower in group II as compared to group I intraoperatively (17.73 ± 1.51 vs 21.80 ± 2.22 μg·dl-1 ) and 30 min postoperatively (15.03 ± 1.56 vs 18.30 ± 1.53 μg·dl-1 ). Blood glucose level was significantly lower in group II as compared to group I intraoperatively (107.57 ± 3.77 vs 115.40 ± 6.30 mg·dl-1 ) and 30 min postoperatively (104.13 ± 3.78 vs 110.73 ± 4.83 mg·dl-1 ). The quality of analgesia as indicated by CHEOPS and OPS scales was significantly better in group II. The consumption of postoperative rescue analgesia was significantly higher in group I as compared to group II (27.00 ± 9.97 vs 13.00 ± 9.43 mg·kg-1 ). TAP block is effective as a part of multimodal analgesia for children undergoing open inguinal hernia repair with significant attenuation in the neuroendocrine stress response induced by surgery.

Surgical pleth index in children younger than 24 months of age: a randomized double-blinded trial

BackgroundThe surgical pleth index (SPI) is a measurement of intraoperative nociception. Evidence of its usability in children is limited. Given that the autonomic nervous system is still developing during the first years of life, the performance of the SPI on small children cannot be concluded from studies carried out in older age groups. MethodsThirty children aged <2 yr, planned for elective open inguinal hernia repair or open correction of undescended testicle, were recruited. The children were randomized into two groups; the saline group received ultrasound-guided saline injection in the ilioinguinal and iliohypogastric nerve region before surgery and ropivacaine after surgery, whereas the block group received the injections in the opposite order. The SPI was recorded blinded and was analysed at the time points of intubation, incision, and when signs of inadequate anti-nociception were observed. ResultsThere was a significant increase in the SPI after intubation (P=0.019) and after incision in the saline group (P=0.048), but not at the time of surgical incision in the block group (P=0.177). An increase in the SPI was also seen at times of clinically apparent inadequate anti-nociception (P=0.008). The between-patient variability of the SPI was large. ConclusionsThe SPI is reactive in small children after intubation and after surgical stimuli, but the reactivity of the SPI is rather small, and there is marked inter-individual variability in reactions. The reactivity is blunted by the use of ilioinguinal and iliohypogastric nerve block. Clinical trial registrationNCT02045810.

Emergency inguinal hernia repair under local anesthesia: a 5-year experience in a teaching hospital.

BackgroundLocal anesthesia (LA) has been reported to be the best choice for elective open inguinal hernia repair because it is cost efficient, with less post-operative pain and enables more rapid recovery. However, the role of LA in emergency inguinal hernia repair is still controversial. The aim of this study is to investigate the safety and effectiveness of LA in emergency inguinal hernia repair.MethodsAll patients underwent emergency inguinal hernia repair in our hospital between January 2010 and April 2014 were analyzed retrospectively in this study. Patients were divided into LA and general anesthesia (GA) group according to the general conditions of the patients decided by anesthetists and surgeons. The outcome parameters measured included time to recovery, early and late postoperative complications, total expense and recurrence.ResultsThis study included a total of 90 patients from 2010 to 2015. 32 patients (35.6 %) were performed under LA, and 58 (64.4 %) were performed under GA. LA group has less cardiac complications (P = 0.044) and respiratory complications (P = 0.027), shorter ICU stay (P = 0.035) and hospital stay (P = 0.001), lower cost (P = 0.000) and faster recovery time (P = 0.000) than GA group.ConclusionLA could provide effective anesthesia and patient safety in emergency inguinal hernia repair.

Multimodal analgesia in inguinal hernia repair using a cyclooxygenase-2-specific inhibitor: A randomised controlled trial

Aim: To determine whether preoperative use of the highly cyclooxygenase-2-specific inhibitor rofecoxib combined with spinal anesthesia offers superior postoperative analgesia compared to spinal anesthesia alone. Methods: Single-centre, randomised, double-blinded, placebo-controlled trial, including 40 adult patients undergoing elective open inguinal hernia repair. Both the control (n=20) and treatment (n=20) groups received 10-12 mg of bupivacaine as local anesthesia and 25 μg of fentanyl as spinal anesthesia. Additionally, control patients received oral placebo, whereas the treatment group received 50 mg of oral rofecoxib 2 hours preoperatively. Results: Resting pain scores were significantly lower in the treatment group at 4, 16 and 24 hours postoperatively, as well as on discharge (p<0.05). Pain scores on active straight-leg raise were significantly lower at 16 hours, 24 hours, and on discharge (p<0.01, p<0.05 and p<0.05 respectively). Time to first analgesic dose was longer (p<0.001) and average analgesic doses were lower (p<0.001) in the treatment group. Finally, side-effect profiles were similar between groups. Conclusions: Preoperative rofecoxib administration in combination with spinal anesthesia is superior to spinal anesthesia alone in controlling pain after inguinal hernia repair. *Corresponding Author: Mostafa Somri, MD, Bnai Zion Medical Center, 47 Golomb St. Haifa, Israel 31048, Tel: +97248359230; E-mail: somri_m@yahoo.com

Role of Prophylactic Antibiotics in Open Inguinal Hernia Repair: A Randomised Study

To study the role of prophylactic antibiotics in open inguinal hernia repair. A total of 200 patients were included, they were randomised in two groups. Group 1 was given prophylactic dose of inj amoxy-clav while group 2 was given placebo only. Results were compared and Data analysed using the Chi-square test. Complications in both the groups were compared. Rate of serous discharge and seroma formation was 1% and 22% respectively in group 1 while 2% and 26% in group 2 also the rate of erythema and stitch abscess were 1% and none in group 1 and 2% and 1% in group 2 respectively. On statistical analysis these differences were not significant. Addition of prophylactic antibiotics in elective open inguinal hernia repair has no significant benefit over placebo although larger studies are required to prepare some uniform guidelines.

Significant Reduction in Incidence of Wound Contamination by Skin Flora Through Use of Microbial Sealant

Application of skin sealant prior to incision reduces microbial contamination of the wound. Prospective, randomized, multicenter clinical trial. Six teaching hospitals. A total of 177 adult patients undergoing elective open inguinal hernia repair were randomized to either standard skin preparation with 10% povidone-iodine or skin preparation followed by cyanoacrylate-based liquid microbial sealant. Wound contamination was assessed during surgery by microbial sampling inside the wound at initiation of skin incision and prior to skin closure. The primary outcome measures were the safety and effectiveness of cyanoacrylate-based microbial sealant to reduce bacterial contamination during surgery. The secondary outcome measure was reduction of postoperative surgical site infections using microbial sealant. Demographics were similar. Patients treated with sealant were more likely to have no bacterial cells found in the wound than control participants (47% vs 31%; P = .04). Three patients developed surgical site infections; all were in the control group (P = .25). Independent factors that reduced wound contamination were use of microbial sealant (odds ratio, 0.45; confidence interval, 0.23-0.88; P = .02) and perioperative antibiotics (odds ratio, 0.24; confidence interval, 0.10-0.58; P = .001). Cyanoacrylate-based microbial sealant may be an important tool to reduce wound contamination and potentially prevent surgical site infections.

100 consecutive claims of alleged negligence in elective open inguinal hernia repair in the UK

100 consecutive claims of alleged negligence in elective open inguinal hernia repair in the UK

One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia.

To evaluate the feasibility and safety of unmonitored local anesthesia (ULA) for elective open inguinal hernia repair, we made a prospective, consecutive data collection from 1000 operations on primary and recurrent hernias. Follow-up consisted of a questionnaire 1 mo after surgery and retrieval from the electronic patient data management system. In 921 ASA Group I and II and 79 ASA Group III and IV patients, the median age was 60 yr (range, 18-95 yr). ULA was converted to general anesthesia in 5 of 1000 cases, and 961 patients were discharged on the day of surgery after 95 min (median; interquartile range, 75-150); 29 patients had complications requiring surgical intervention. Within the first month, three patients died of causes unrelated to hernia surgery, and six had cardiovascular or respiratory events. The questionnaire was returned by 940 patients; 124 were dissatisfied with local anesthesia, day-case setup, or both, primarily because of intraoperative pain (n = 74; 7.8%). We conclude that open inguinal hernia repair can be conducted under ULA, regardless of comorbidity, with a small rate of deviation from day-case setup and minimal morbidity. It provides a safe alternative to other anesthetic techniques with an acceptable rate of satisfaction, but intraoperative pain relief needs improvement. Inguinal hernia repair can be safely performed under unmonitored local anesthesia with infrequent postoperative morbidity and acceptable satisfaction, but intraoperative pain may be a problem.