Ambulatory Hernia Surgery

  • R. LorenzEmail author


The chapter will give an overview about the existing literature about ambulatory hernia surgery with definition, history, evidence, international comparison and guidelines.

Already the ambulatory surgery terminology shows some differences internationally. In many countries, the term ambulatory surgery means that the patient spends the night before and after the operation at home.

Outpatient inguinal hernia surgery has become increasingly popular internationally in recent decades. Since 1955 exist various publications about the advantages of outpatient inguinal hernia surgery with faster mobilisation, high patient satisfaction and lower costs.

Most surgeons agree that today the majority of inguinal hernias can be done as a day case if appropriate home care is ensured. There are no restrictions even in endoscopic procedures, in patients over the age of 65 years, in patients with obesity or in the presence of comorbidities.

In many European countries, there has been a steady rise in the proportion of outpatient inguinal surgery operations. The proportion of outpatient hernia operations thus varies between 0 and 80%. In most countries, however this is no systematic recording of all the operations.

Healthcare financing and reimbursement appear to have a decisive influence on outpatient surgery.

We have also analysed the current data from the German hernia registry Herniamed to compare day case hernia cases with hospital cases. There seem to be not any significant differences in complication rates, in pain or in recurrence rates between the two sectors. Overall the analysis permits the conclusion that outpatient inguinal hernia surgery can be performed without significant detriment for the patients.



R. Lorenz declares the following conflicts of interest: C. R. BARD: Consultant for Speakers Bureau, Hands-On Hernia Training Courses.


  1. 1.
    Toftgaard C, Parmentier G. International terminology in ambulatory surgery and its worldwide practice. In: Lemos P, Jarett B, Philip B, editors. Day surgery—development and practice. London: IAAS; 2006. p. 35–9.Google Scholar
  2. 2.
  3. 3.
    David G, Neumann MD. The changing geography of outpatient procedures. LDI Issue Brief. 2011;16(5):1–4.PubMedGoogle Scholar
  4. 4.
    Farquharson EL. Early ambulation; with special reference to herniorrhaphy as an outpatient procedure. Lancet. 1955;269:517–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Engbaek J, Bartholdy J, Hjortsø N-C. Return hospital visits and morbidity within 60 days after day surgery: a retrospective study of 18,736 day surgical procedures. Acta Anaesthesiol Scand. 2006;50(8):911–9. Scholar
  6. 6.
    Dhumale R, Tisdale J, Barwell N. Over a thousand ambulatory hernia repairs in a primary care setting. Ann R Coll Surg Engl. 2010;92(2):127–30. Scholar
  7. 7.
    Majholm B, Engbaek J, Bartholdy J, et al. Is day surgery safe? A Danish multicentre study of morbidity after 57,709 day surgery procedures. Acta Anaesthesiol Scand. 2012;56(3):323–31.CrossRefPubMedGoogle Scholar
  8. 8.
    Kurzer M, Kark A, Hussain ST. Day-case inguinal hernia repair in the elderly: a surgical priority. Hernia. 2009;13(2):131–6. Epub 2008 Nov 26.CrossRefPubMedGoogle Scholar
  9. 9.
    Mattila K, Vironen J, Eklund A, Kontinen VK, Hynynen M. Randomized clinical trial comparing ambulatory and inpatient care after inguinal hernia repair in patients aged 65 years or older. Am J Surg. 2011;201(2):179–85.CrossRefPubMedGoogle Scholar
  10. 10.
    Sanjay P, et al. Lichtenstein hernia repair under different anaesthetic techniques with special emphasis on outcomes in older people. Australas J Ageing. 2011;30(2):93–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Amato B, Compagna R, Fappiano F, Rossi R, Bianco T, Danzi M, Accurso A, Serra R, Aprea G, Massa S. Day-surgery inguinal hernia repair in the elderly: single centre experience. BMC Surg. 2013;13(Suppl 2):S28. Epub 2013 Oct 8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Palumbo P, Amatucci C, Perotti B, Zullino A, Dezzi C, Illuminati G, Vietri F. Outpatient repair for inguinal hernia in elderly patients: still a challenge? Int J Surg. 2014;12(Suppl 2):S4–7. Epub 2014 Aug 24.CrossRefPubMedGoogle Scholar
  13. 13.
    Grifasi C, Calogero A, Esposito A, Dodaro C. Perioperative care of elderly outpatient. A review. Ann Ital Chir. 2015;86(2):100–5.PubMedGoogle Scholar
  14. 14.
    Acevedo A, Leon J. Day case hernia surgery under local anaesthesia is feasible and safe in obese patients. Hernia. 2010;14:57–62.CrossRefPubMedGoogle Scholar
  15. 15.
    Pere P, Harju J, Kairaluoma P, Remes V, Turunen P, Rosenberg PH. Randomized comparison of the feasibility of three anesthetic techniques for day-case open inguinal hernia repair. J Clin Anesth. 2016;34:166–75. Epub 2016 May 8.CrossRefPubMedGoogle Scholar
  16. 16.
    Cassinotti E, Colombo EM, Di Giuseppe M, Rovera F, Dionigi G, Boni L. Current indications for laparoscopy in day-case surgery. Int J Surg. 2008;6(Suppl 1):S93–6. Epub 2008 Dec 13.CrossRefPubMedGoogle Scholar
  17. 17.
    Ngo P, Pélissier E, Levard H, et al. Ambulatory groin and ventral hernia repair. J Visc Surg. 2010;147(5):e325–8. Epub 2010 Oct 14.CrossRefPubMedGoogle Scholar
  18. 18.
    Lorente-Herce JM, et al. Incisional hernia repair in an ambulatory surgery-extended recovery centre: a review of 259 consecutive cases. Hernia. 2015;19(3):487–92.CrossRefPubMedGoogle Scholar
  19. 19.
    Wirth U, Saller ML, von Ahnen T, Köckerling F, Schardey HM, Schopf S. Inguinal hernia repair in TAPP technique in a day-case surgery setting—at what price? Chirurg. 2017;88(9):792–8. [Epub ahead of print].CrossRefPubMedGoogle Scholar
  20. 20.
    Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343–403. Epub 2009 Jul 28.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Miserez M, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernias in adult patients. Hernia. 2014;18:151–63.CrossRefPubMedGoogle Scholar
  22. 22.
    HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;12:1–165. doi: [Epub ahead of print] PMID: 29330835.
  23. 23.
    Dholakia S, Jeans JP, Khalid U, Dholakia S, D’Souza C, Nemeth K. The association of noise and surgical-site infection in day-case hernia repairs. Surgery. 2015;157(6):1153–6. Epub 2015 Feb 28.CrossRefPubMedGoogle Scholar
  24. 24.
    Frassanito L, Pitoni S, Gonnella G, Alfieri S, Del Vicario M, Catarci S, Draisci G. Utility of ultrasound-guided transversus abdominis plane block for day-case inguinal hernia repair. Korean J Anesthesiol. 2017;70(1):46–51. Epub 2016 Oct 25.CrossRefPubMedGoogle Scholar
  25. 25.
    Jarrett PEM. Day care surgery. Eur J Anaesthesiol. 2001;18(S23):32–5. Scholar
  26. 26.
    McCormack K, Scott NW, Go PM, Ross S, Grant AM. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2003;(1):CD001785.
  27. 27.
    Rodriguez-Cuellar E, Villeta R, Ruiz P, et al. National project for the management of clinical processes. Surgical treatment of inguinal hernia. Cir Esp. 2005;77(4):194–202. doi: 13073287.CrossRefPubMedGoogle Scholar
  28. 28.
    Holzheimer RG. First results of Lichtenstein hernia repair with Ultrapro-mesh as cost saving procedure—quality control combined with a modified quality of life questionnaire (SF-36) in a series of ambulatory operated patients. Eur J Med Res. 2004;9(6):323–7.PubMedGoogle Scholar
  29. 29.
    Toftgaard C, Parmentier G. International Association for Ambulatory Surgery (IAAS). 2005.Google Scholar
  30. 30.
  31. 31.
    Cariati A, Piromalli E. Cutting costs in inguinal hernia surgery: laparoscopic or ambulatory (or 1-day) open hernia (Lichtenstein) repair? Indian J Surg. 2013;75(5):409. Scholar
  32. 32.
    Weyhe D, Winnemöller C, Hellwig A, Meurer K, Plugge H, Kasoly K, Laubenthal H, Bauer KH, Uhl W. (section sign) 115 b SGB V threatens outpatient treatment for inguinal hernia. Analysis of outcome and economics. Chirurg. 2006;77(9):844–55. Brökelmann J. BAO-Depesche Nr. 19, Dez. 2009, 18–19.CrossRefPubMedGoogle Scholar
  33. 33.
    Schulz G. Kosten und Erlöse des Ambulanten Operierens. Ambulant Operieren. 2008;2008:125–30.Google Scholar
  34. 34.
    Brökelmann J. Ambulant Operieren 4/2000. p. 199.Google Scholar
  35. 35.
    Koch A, Lorenz R, Meyer F, Weyhe D. Hernia repair at the groin—who undergoes which surgical intervention? Zentralbl Chir. 2013;138(4):410–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Lorenz R. Unpublished data from the German Hernia Database Herniamed—Chirurgische Praxis, 2017, in press.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hernia Center 3+CHIRURGENBerlinGermany

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