[Total extraperitoneal inguinal hernia repair under local anesthesia].

Abstract

Objective: To study the possibility of total extraperitoneal inguinal hernia repair under local anesthesia in patients with contraindications for general or regional anesthesia.

Material and methods: A retrospective clinical trial involved 14 patients who underwent total extraperitoneal inguinal hernia repair under local anesthesia with lidocaine between 2019 and 2022. Potential indications for this surgery under local anesthesia may be certain clinical situations and their combinations: high anesthetic risk, anatomical difficulties for regional anesthesia, coagulopathy, long-term antithrombotic therapy, refusal of patient from general and regional anesthesia.

Results: There was ASA grade IV in 13 (92.9%) patients. Mean age of patients was 73.5 (64.0; 84.0) years, Charlson comorbidity index - 5.0 (4.3; 6.0) points. All patients with inguinal hernia successfully underwent total extraperitoneal inguinal hernia repair under local anesthesia. There were no conversions to open surgery or general anesthesia. Three (21.4%) patients developed intraoperative pneumoperitoneum that required intravenous administration of opioid analgesic. After that, endoscopic surgery was successfully continued in all cases. There were no typical postoperative complications of herniation. Patient activation occurred after 2-3 hours after surgery. Narcotic analgesics in postoperative period were not required in any case. Mean hospital-stay was 25.0 (21.7; 42.0) hours. No recurrence of hernias was observed within 7.5 (6.3; 14.3) months.

Conclusion: Total extraperitoneal inguinal hernia repair under local anesthesia is a technically feasible intervention in patients with limitations to general or regional anesthesia.