Acta chirurgica Iugoslavica 2012 Volume 59, Issue 1, Pages: 87-93
https://doi.org/10.2298/ACI1201087D
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"One step procedure" local anaesthesia for inguinal hernia repair in ambulatory surgery conditions: District general hospital experience
Dabić Dejan (Department of Surgery, General Hospital Čačak, Čačak)
Peruničić Vladan (Department of Surgery, General Hospital Čačak, Čačak)
Marić Biljana (Department of Surgery, General Hospital Čačak, Čačak)
Ambulatory surgery refers to hospitalization that does not exceed 24 hours,
during which a surgical procedure is performed. Inguinal hernia repairs done
under local anaesthesia on an outpatient basis are no longer performed
exclusively in specialized hernia centers. They are becoming widely accepted
by surgeons working in district hospitals, which was significantly
contributed to by the publication of the EHS Guidelines on the Treatment of
Inguinal Hernia. OBJECTIVE: The objective of this retrospective study is to
show local anaesthesia practicability for inguinal hernia repairs through
"one-step procedure", being a one-day procedure used in District General
Hospital. METHODS: From January 2006 to June 2011, 460 elective surgery
procedures were performed on 428 patients with inguinal hernia (396 with
unilateral and 32 with bilateral inguinal hernia), using Lichtenstein
technique, UHS/PHS, plug repair, and Shouldice technique. All the proceduress
were performed under local anaesthesia by the same surgeon using "one-step
procedure" in ambulatory surgery. The following anaesthetics were used:
Lidocaine for intradermal and subcutaneous anaesthesia as well as
Bupivacaine/Levobupivacaine for subfascial anaesthesia. RESULTS: From January
2006 to June 2011, 460 surgical procedures were performed on 428 patients
with inguinal hernia (396 with unilateral and 32 with bilateral inguinal
hernia). The mean age was 58.2 yrs (20-84). All the patients were in the ASA
I - III group. In unilateral hernias, the mean operating time using
Lichtenstein technique was 38mins (28-56), using PHS/UHS 28mins (22-40), with
plug 33mins (27- 39) and using Shouldice technique 43mins (32-53). In
bilateral hernias, the mean operating time using Lichtenstein technique was
71mis (56-87), and using PHS /UHS 56mins (49-64). The mean hospital stay was
2.9hrs (2-6). The mean distance of residence from the hospital was 23km
(1-150). During the course of the surgery, 15 patients (3.5%) had problems
such as pain, bradycardia, hypotension, or perspiration. The complications
during the mean follow-up of 31 months (1-60) was: 1.4% (6 patients) - a
hematoma, 1.87% (8 patients) - seroma, 0.47% (2 patients) - wound infection,
0.23% (1 patient) - chronic pain, and 0.47% (2 patients) - recurrence.
Revision due to active bleeding was conducted in two patients (0.47%), after
using PHS and Lichtenstein techniques. These were the only patients who were
rehospitalized due to complications. CONCLUSION: In hernia repairs on an
outpatient basis, "one-step procedure" in local anaesthetic administration is
reliable, easy, safe, effective, and the type of the surgical technique is
not a determining factor. The success rate and treatment outcome depend on
the surgical technique and the surgeon’s experience in using local
anaesthesia in ambulatory surgery.
Keywords: local anaesthesia, "one-step procedure", ambulatory surgery, inguinal hernia