Abstract :
[en] LICHTENSTEIN REPAIR UNDER LOCAL ANAESTHESIA
Pr Olivier Detry,
Dpt of Abdominal Surgery and Transplantation, CHU Liège, Liège, Belgium.
Email: oli.detry@chu.ulg.ac.be
Despite many studies confirming the feasibility and the interest of local anaesthesia for inguinal hernia repair [1-3], its use is not generalized amongst abdominal surgeons. The advantages of local anaesthesia are indeed clear, including reduced costs, reduced hospital stay and reduced post operative pain. The success of the procedure depends on the skills and the motivation of the surgeon, of the nursing teams, and of the patient him/herself. Perfect knowledge of the surgical technique and of the regional nerve anatomy is required. The Lichtenstein repair may be easily performed under local anaesthesia, but should be proposed in the early experience to non-obese patients suffering from limited inguinal hernia. It can even be performed by surgical residents [4].
Practically, local anaesthesia requires some patience and quiet in the operative room. Operators should be aware that the action of local anaesthesia is delayed after injection. Local anaesthetics should be buffered [5] and at body temperature at time of injection. Local anaesthetics containing Adrenalin allow longer pain control, with limitation of bleeding and less toxicity. Large and brutal movements should be avoided. Transversus abdominis plane (TAP) block can also be proposed [6].
The surgical and anaesthetic techniques for inguinal hernia repair should be tailored to the specific characteristics of the hernia and of the patient. There is no method of choice that might fit for every patient.
References
[1] van Veen RN, Mahabier C, Dawson I, Hop WC, Kok NF, Lange JF, et al. Spinal or local anesthesia in lichtenstein hernia repair: a randomized controlled trial. Ann Surg 2008;247:428-433.
[2] Verstraete L, Becaus N, Swannet H, Ceelen W, Duchateau L, Speybroeck N. Long term outcome after lichtenstein hernia repair using general, locoregional or local anaesthesia. Acta Chir Belg 2015;115:136-141.
[3] Dhankhar DS, Sharma N, Mishra T, Kaur N, Singh S, Gupta S. Totally extraperitoneal repair under general anesthesia versus Lichtenstein repair under local anesthesia for unilateral inguinal hernia: a prospective randomized controlled trial. Surg Endosc 2014;28:996-1002.
[4] Paajanen H, Varjo R. Ten-year audit of Lichtenstein hernioplasty under local anaesthesia performed by surgical residents. BMC Surg 2010;10:24.
[5] Ball EL, Sanjay P, Woodward A. Comparison of buffered and unbuffered local anaesthesia for inguinal hernia repair: a prospective study. Hernia : the journal of hernias and abdominal wall surgery 2006;10:175-178.
[6] Milone M, Di Minno MN, Musella M, Maietta P, Salvatore G, Iacovazzo C, et al. Outpatient inguinal hernia repair under local anaesthesia: feasibility and efficacy of ultrasound-guided transversus abdominis plane block. Hernia : the journal of hernias and abdominal wall surgery 2013;17:749-755.
