Simultaneous Repair of Bilateral Inguinal Hernia under Local Anaesthesia

Abstract

Open repair of inguinal hernias is a recognised standard approach to groin hernia repairs. Furthermore, this approach is uniquely suited to repair under local anaesthesia (LA). LA repair of unilateral Inguinal hernia (IH) is widely reported in the literature as a safe, well tolerated, and effective operation.  However, there is minimal evidence in literature on simultaneous repair of bilateral inguinal hernias under local anaesthesia.  This approach is a useful tool in patients with bilateral IH who are unfit for or choose to avoid general anaesthesia (GA). We report our experience with simultaneous repair of bilateral inguinal hernias under local anaesthetic. Methods: We reviewed prospectively collected data of patients with bilateral inguinal hernias for whom simultaneous repair under LA was performed between 2009 – 2019. Data was collected for patient demographics, post-operative visual analogue pain score (VAS), operating time, volume of local anaesthetic used, patient satisfaction and complication rates. All patients had a Lichtenstein's hernioplasty using a buffered local anaesthetic mixture made up of 30ml 0.5% Bupivacaine with adrenaline, 20 ml 2% Lignocaine with adrenaline, 50 ml of 0.9% Saline and 6 ml of 8.6% Sodium Bicarbonate. In each patient, both procedures were performed sequentially as a day case operations. Results: In total, 24 patients were included in the study with male preponderance (92%) and only two were females.  Their ages ranged 35 - 81 years. Their BMI varied from 18 – 30 , with a mean of 24.The average operating time was 66.8 minutes (ranging 38 - 120 minutes, median 60 min).  The mean pain score was 24, on a VAS 0-100 scale (range 4 - 50, median 25) with patient satisfaction scores  (0-100 scale) varying from 50-100 (Median 90, Mean 88.1). Conclusion: We conclude that successful simultaneous repair of bilateral inguinal hernia under local anaesthetic can be performed safely in a timely fashion, with minimal patient discomfort and high satisfaction rate. This approach should be considered as a viable alternative in the tailored approach to repairing IHs0 and offered to patients not deemed suitable for elective general anaesthesia with the advantage of addressing both groin hernias during the same operating session.