The feasibility of laparoscopic extraperitoneal hernia repair under local anesthesia

Background: Laparoscopic preperitoneal herniorrhaphy has the advantage of b eing a minimally invasive procedure with a recurrence rate comparable to op en preperitoneal repair. However, surgeons have been reluctant to adopt thi s procedure because it requires general anesthesia Methods: In this report, we describe the technique used in the laparoscopic repair of inguinal hernias under local anesthesia using the preperitoneal approach. We also report our results with 10 inguinal hernias repaired usin g the same technique. Results: Ten patients underwent their primary inguinal hernia repairs under local anesthesia. None were converted to general anesthesia. Four patients received a small amount of intravenous sedation. Three patients had bilate ral hernias, There were five direct and eight indirect hernias. The average operative time was 47 min. The average lidocaine usage was 28 cc, All pati ents were discharged within a feu hours of the surgery. There were no compl ications. Follow-up has ranged from 1 to 6 months. There has been no recurr ences to date. Conclusions: The extraperitoneal laparoscopic repair of inguinal hernia is feasible under local anesthesia. This technique adds a new treatment option in the management of bilateral inguinal hernias, particularly in the popul ation when general anesthesia is contraindicated or even for patients who a re reluctant to receive general or epidural anesthesia.