This option appears safe for patients who are considered high-risk for general anesthesia.
Context
Symptomatic inguinal hernias usually warrant consideration of surgical repair, but for some patients, the risks of general anesthesia are a limiting factor. An alternative is to use local anesthesia through an ilioinguinal nerve block, and limited data suggest this option might work just as well. In a single-center study, investigators report outcomes of this surgical approach for 164 patients (mean age, 71; 15% with diabetes; 45% with prior cardiac disease), nearly all with unilateral inguinal hernias, during an average follow-up of 1.5 years.
Key Results
- No intraoperative complications occurred.
- The most common postoperative complication was a local seroma (15 patients; 9%); one patient had a temporary drain placed; all others resolved with observation.
- Urinary retention occurred in six patients (4%) and local cellulitis in three patients (2%).
- There were no hernia recurrences or mesh infections.
- The average total bill was ≈$6,000.
Comment
I’m occasionally wary about referring patients with significant comorbidities for inguinal hernia repair, especially when symptoms are minimal, so it is helpful to know about the safety of this alternative approach. In addition, the average price tag is likely much lower than robotic and laparoscopic approaches, an increasingly important consideration given cost burdens on patients in our health care system. Clinicians can discuss the availability of this surgical option in their area with trusted surgical colleagues.