[Bi-layer hernioplasty in day surgery]

Nowadays the modern surgical techniques of hernia repair highly consider not only the decrease of the recurrence rate, but also a fast recovery, minimal postoperative pain and low costs of this type of surgery. This paper presents the preliminary results of a study performed on 41 patients diagnosed with inguinal hernia and operated under local anesthesia, as day surgery cases, during 2004-2006. The selection of the patients was performed under the "Guidelines and Standards for Day Surgery in Australia". We used local "step by step" anesthesia with a solution of 20 ml of lydocaine 1%, 20 ml of marcaine 0.5% and and 20 ml of NaCl 0.9%. The surgical procedure based on the sutureless technique "Gilbert", implied the placement of two polypropylene meshes: one of them introduced through the deep inguinal ring, and the other one in the inguinal channel, minimally fixed. We studied: intraoperative comfort and postoperative pain of the patients, problems related to the surgical technique, the operative time, complications and the recurrence rate. The follow-up period was 14 months. 85.36% of the patients had a very good intraoperative comfort, and only 14.64 % of them needed supplementary intravenous analgesia; none of the patients needed conversion to general anesthesia. The mean operative time was 65 minutes. The complications were: seroma (3 patients) and hematoma (1 patient), all of them treated conservatively. No recurrence was noticed. From this preliminary study it seems that the surgical treatment of the inguinal hernia with double polypropylene mesh, under local anesthesia and as day surgery is feasible and secure. The minimal postoperative complications and the patients' satisfaction show that the new concept of day surgery must be promoted in our surgery clinics. However, we must emphasize that, in order to obtain good results on a larger scale, certain measures are mandatory, such as: organizing a special area and circuits for day surgery, nursing at home, precise inform of the patients (video samples), the use of modern communication (internet) with patients.