Tension-free hernioplasty of recurrent inguinal hernia under local anaesthesia: a 5-year review

The aim of this study was to describe the tension-free hernioplasty of recurrent inguinal hernia under local anaesthesia via the anterior approach, in order to evaluate the feasibility, safety and effectiveness of local anaesthesia and its outcome in terms of hernia recurrence and chronic inguinal pain. The effects of hernia type, type of anaesthesia, comorbid disease and complications on recurrence and chronic inguinal pain were analysed. Fifty-nine procedures were performed electively on 56 adult patients. Local anaesthesia was used in all patients. In 4 patients (7%) a shift from local to general anaesthesia became necessary to conclude the procedure due to intra-operative pain. Three cases (5%) with a bilateral inguinal hernia were treated at the same time. Thirty-five (59%) recurrences were repaired with the technique proposed by Lichtenstein, 13 cases (22%) with the dynamic self-regulating (P.A.D.) system, and 11 cases (19%) with a plug repair. After a median follow-up of 96 months there was only 1 recurrence (1.6%) and 1 case of chronic inguinal pain (1.6%). We conclude that use of local anaesthesia is indicated in recurrent inguinal hernia not only for its simplicity, safety and lasting postoperative analgesia, but especially for the lack of potentially detrimental cardiovascular effects observed with general anaesthesia.