VERY LARGE INGUINAL-HERNIAS CAN ALSO BE T REATED UNDER LOCAL-ANESTHESIA

In patients with a large inguinal hernia, surgeons are usually relucta nt to use a local anesthesia as described in the Shouldice technique. The purpose of this study was to appreciate the efficiency of such a t echnique. Routine local anesthesia used 200 cc of 0.5% lidocaine injec ted subcutaneously in the groin area and more deeply, near the anterio r superior iliac spine in order to achieve a nerve block of the genita l branches of the ilioinguinal and genitofemoral nerves, If necessary, the peritoneal sac is injected with lidocaine: it is usually not open ed, just pushed back into the abdomen. At the end of the procedure, th e estimated size of the peritoneal sac, the presence of pain, the nece ssity of converting the local anesthetic technique into an other proce dure and the use of a prosthesis were recorded in the patient's charts . From January 1986 to December 1992, all patients with an inguinal he rnia mure than 6 cm in diameter, were included in the study. ill conse cutive patients were defined as having a large hernia and were operate d by one of the authors. 3 patients were excluded, following general a nesthesia as the first approach, males leaving 108 cases, The mean age was 59.8 years (range: 21 to 92). There were 103 males and 5 females, 60 right hernias, 37 left and 11 bilateral of which 4 were bilateral and large, giving a total of 112 large hernias. The mean diameter of t he sac was 8.6 cm (range : 6 to 30). 7 patients were operated for recu rrent large hernia. During the procedure, 9 patients reported pain whi ch necessitated repeated injections of local anesthetic. The local pro cedure never had to he converted into general anesthesia. All patients had a Shouldice repair and none required the use of a prosthesis. Pat ients were reviewed after a mean of 36 months of postoperative course (from 5 to 79 months). No hernia recurrence was observed, five patient s had ''residual'' pain.