Inguinal hernia repair: local or general anaesthesia?

Area of Science:

• Surgical outcomes research
• Hernia repair techniques
• Anesthesia in surgery

Background:

• Specialist hernia centres achieve high success rates for inguinal hernia repair using local anaesthesia (LA).
• Reproducibility of these results in UK National Health Service (NHS) district general hospitals is not well-documented.
• Current data is limited regarding the effectiveness of LA in routine hospital settings.

Purpose of the Study:

• To evaluate the outcomes of inguinal hernia repairs performed in a district general hospital over a 9-year period.
• To compare local anaesthesia (LA) versus general anaesthesia (GA) for inguinal hernia repair.
• To assess patient satisfaction and recurrence rates, and to survey current practices in Wales.

Main Methods:

• Retrospective analysis of 577 inguinal hernia repairs.
• Data collected on anesthesia type, complications, recurrence, and day-case rates.
• Postal questionnaires used for patient satisfaction and surgeon practices in Wales.

Main Results:

• 64% of repairs used local anaesthesia (LA), 36% used general anaesthesia (GA).
• LA was associated with significantly higher day-case rates (82.6% vs 42.6%) and lower postoperative analgesic needs.
• Recurrence rate was low (1.2%) at a median follow-up of 5.1 years; LA patients reported higher satisfaction.

Conclusions:

• Local anaesthesia (LA) increases day-case rates and reduces postoperative complications for inguinal hernia repair.
• Excellent outcomes achieved by specialist centres are reproducible in district general hospitals.
• Increased use of LA for inguinal hernia repair is recommended.