Local anaesthesia as a risk factor for recurrence after groin hernia repair

The literature is inconclusive regarding the effect of local infiltration anaesthesia on the risk of recurrence after groin hernia repair.

Based upon the Danish Hernia Database, reoperations after a primary Lichtenstein mesh repair were assessed in 43,123 patients between 1998 and 2005. Data were analysed in relation to type of inguinal hernia and whether repaired in public hospitals or by private hernia surgeons.

The nationwide data showed no overall difference in reoperation rate (about 3.5% after five years), whether performed in local or general/regional anaesthesia. Reoperation rates were about 50% higher when performed for a direct hernia than for an indirect hernia. The use of local anaesthesia was followed by higher reoperation rates compared with general or regional anaesthesia after repair of a direct but not an indirect hernia in hospitals. However, reoperation rates after both direct and indirect hernia repairs were lower among private hernia surgeons, with uniform use of local anaesthesia compared with reoperations following primary surgery in hospitals.

These extensive nationwide data suggest that surgical experience and hernia type may be important factors for reoperation, and that it is independent of the type of anaesthesia. When performed in general hospitals, local anaesthesia may be a risk factor for recurrence after primary repair of a direct hernia.