Anesthesia and surgical repair of aponeurotic hernias in ambulatory surgery
Introduction
The umbilicus is a cutaneous scar attached to a fibrous ring. This area of the anterior abdominal wall is weak and a common site of acquired hernias, as a consequence of a rise in intraabdominal pressure and deterioration of connective tissue [1], [2]. The estimated prevalence of umbilical hernias (UH) in the adult population is 2% [3]. Epigastric hernias (EH) arise in defects in the midline aponeurosis as a consequence of alterations in the fascial fibers decussations [4]. The risk of incarceration and strangulation in patients with midline primary hernias requires elective surgical repair to prevent these complications [5]. Although most of UH in these patients are thought to need general anesthesia and hospital admission, the introduction of new anesthetic agents (propofol, sevoflurane) and the advantageous application of tension-free repair to the inguinal defects suggested to us the possibility of operating on these patients in an ambulatory setting [6], [7], [8]. The aim of our present study was to evaluate the results of a protocol of local anesthesia and sedation for the surgical treatment of EH and UH in an ambulatory unit.
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Patients and methods
Patients underwent routine preoperative evaluation consisting of blood test, chest X-ray and electrocardiogram. Exclusion criteria included ASA III-IV classification, morbid obesity, insulin-dependent diabetes and social or housing problems. All the patients were admitted on the day of operation. Discharge of patients after elective hernia repair was scheduled for the evening of the day of surgery. Comprehensive and consistent information is provided at first consultation and a signed informed
Results
From January 1994 to January 1999, 157 patients with midline hernias have been operated in our department: 138 UH and 19 EH. Of these, 88 (63.7%) UH and 13 (68.4%) EH could be successfully operated on an ambulatory basis. Mean age was 46.1±13.9 years (range: 18–86) and 43.6% (n=44) were females. Mean body mass index (BMI) of patients included was 27.2±0.75 (range: 17.3–41.5). There were several concomitant associated diseases in the patients undergoing ambulatory surgery: moderate obesity
Discussion
Adult umbilical and epigastric hernias have not received so much attention in the recent literature as other defects of the abdominal wall. While inguinal and crural hernias are commonly repaired in one day surgery programs, ambulatory repair of aponeurotic hernias remains controversial. There is a serious risk of incarceration in umbilical hernias with a high associated morbidity and mortality [12], [13]. Thus elective repair is nearly always indicated [5].
With experience our selection
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Which surgical technique for an uncomplicated umbilical hernia?
2004, Annales de ChirurgieGuidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society
2020, British Journal of Surgery