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Feasibility and limits of inguinal hernia repair under local anaesthesia in a limited resource environment: a prospective controlled study

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Abstract

Purpose

Local anaesthesia (LA) has proven effective for inguinal hernia repair in developed countries. Hernias in low to middle income countries represent a different issue. The aim of this study was to analyse the feasibility of LA for African hernia repairs in a limited resource environment.

Methods

Data from patients who underwent herniorrhaphy under LA or spinal anaesthesia (SA) by the 6th and 7th Forward Surgical Team were prospectively collected. All of the patients benefited from a transversus abdominis plane (TAP) block for postoperative analgesia. Primary endpoints concerned the pain response and conversion to general anaesthesia. Secondary endpoints concerned the complication and recurrence rates. Predictors of LA failure were then identified.

Results

In all, 189 inguinal hernias were operated during the study period, and 119 patients fulfilled the inclusion criteria: 57 LA and 62 SA. Forty-eight percent of patients presented with inguinoscrotal hernias. Local anaesthesia led to more pain during surgery and necessitated more administration of analgesics but resulted in fewer micturition difficulties and better postoperative pain control. Conversion rates were not different. Inguinoscrotal hernia and a time interval <50 min between the TAP block and skin incision were predictors of LA failure. Forty-four patients were followed-up at one month. No recurrence was noted.

Conclusions

Local anaesthesia is a safe alternative to SA. Small or medium hernias can easily be performed under LA in rural centres, but inguinoscrotal hernias required an ultrasound-guided TAP block performed 50 min before surgery to achieve optimal analgesia, and should be managed only in centres equipped with ultrasonography.

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Authors and Affiliations

  1. Department of Oncologic and General Surgery, Sainte Anne Military Hospital, 6th Forward Surgical Team, Boulevard Sainte Anne, 83000, Toulon, France

    S. Bourgouin

  2. Department of General Surgery, Laveran Military Hospital, 7th Airborne Forward Surgical Team, Marseille, France

    Y. Goudard

  3. Department of Intensive Care and Anaesthesiology, Sainte Anne Military Hospital, 6th Forward Surgical Team, Toulon, France

    A. Montcriol

  4. Department of Intensive Care and Anaesthesiology, Sainte Anne Military Hospital, 7th Airborne Forward Surgical Team, Toulon, France

    J. Bordes

  5. Department of Intensive Care and Anaesthesiology, Laveran Military Hospital, Marseille, France

    A. Nau

  6. Department of Oncologic and General Surgery, Sainte Anne Military Hospital, Toulon, France

    P. Balandraud

  7. French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France

    P. Balandraud

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  1. S. Bourgouin
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  2. Y. Goudard
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  4. J. Bordes
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Corresponding author

Correspondence to S. Bourgouin.

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Conflict of interest

S. Bourgouin, Y. Goudard, A. Montcriol, J. Bordes, A. Nau and P. Balandraud have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Bourgouin, S., Goudard, Y., Montcriol, A. et al. Feasibility and limits of inguinal hernia repair under local anaesthesia in a limited resource environment: a prospective controlled study. Hernia 21, 749–757 (2017). https://doi.org/10.1007/s10029-017-1631-x

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  • DOI: https://doi.org/10.1007/s10029-017-1631-x

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