Original Articles
Three Thousand One Hundred Seventy-Five Primary Inguinal Hernia Repairs: Advantages of Ambulatory Open Mesh Repair Using Local Anesthesia

https://doi.org/10.1016/S1072-7515(98)00057-XGet rights and content

Abstract

Background: Controversy exists over the relative advantages of open mesh repair compared with open stitching methods and the laparoscopic approach.

Study Design: Two thousand nine hundred six (2,906) consecutive unselected adult patients underwent 3,175 primary inguinal hernia repairs using polypropylene mesh, under local anesthesia on an ambulatory basis. The age range was 15–92 years. The study specifically investigated the postoperative course with regard to pain, complications, and time of return to work.

Results: There were no postoperative deaths and no cases of urinary retention. Two percent of patients developed a hematoma. The incidence of deep infection was 0.3%. No case of testicular atrophy occurred. Postoperatively 19% of patients used no analgesia at all; 60% used oral analgesics for up to 7 days. There was a gradual decrease in time of return to work over four successive 1-year periods. Manual workers returned to work in 15 days (median) in the first year, reducing to 9 days in the fourth year. The overall median time of return to work across the whole group was 9 days. There were eight recurrences with an 18-month to 5-year followup.

Conclusions: Open mesh repair under local anesthesia is an effective day case technique, particularly in the elderly and medically unfit. The economic benefits are enhanced by low morbidity, early return to normal activities and low recurrence rates.

Section snippets

Materials and Methods

The British Hernia Centre is a private free-standing day surgery clinic with full operating facilities, monitoring, and recovery suite. All operations were undertaken by three surgeons with a special interest in hernia surgery.

Within 1 Month

Early complications are detailed in Table 1. There were no postoperative deaths and no case of urinary retention. Eight patients had anterior thigh muscle weakness and all recovered within 2–3 hours. Two patients required wound reexploration for persistent bleeding within hours of completion of the operation with immediate resuture of the skin followed by uninterrupted recovery. There was clinical evidence of a thrombotic complication in two patients: in one, calf pain occurred on the second

Discussion

The surgical literature is replete with reports and trials of hernia repairs using a variety of methods.2, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 Many do not separate the treatment and results of repair of primary and recurrent hernias, which are separate entities with different causes, a different pathology, and requiring different methods of repair. This analysis is restricted to a review of primary inguinal hernia repairs.

The first major variation of the Bassini hernia

Acknowledgements

We thank Mr. Andrew Westlake, msc fss for statistical advice and review, Mrs. Marlena Stanboulian for all secretarial work, and Mrs. Lara Samuels for data collection.

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