Anterior tension-free repair of recurrent inguinal hernia under local anesthesia - A 7-year experience in a teaching hospital

Objective To describe a 7-year experience with recurrent inguinal hernia repair perfo rmed mainly with tension-free mesh or plug technique under local anesthesia through the anterior approach, and to evaluate the safety and effectivenes s of this method of treatment. Methods One hundred forty-five elective and 1 emergency herniorrhaphies for recurre nt groin hernia were performed in 141 subjects (134 men and 7 women) with a mean age of 65 years (range 30-89). Concomitant medical and surgical probl ems were present in 73% and 8% of subjects, respectively. In 28 instances, the relapsed hernia had already been operated on once or twice for recurren ce. A traditional hernioplasty had been previously performed in the vast ma jority of cases (136). Tension-free mesh or plug techniques through an ante rior approach under local anesthesia were performed in 144 reoperations. Pr eperitoneal mesh repair and general or spinal anesthesia were used in ail b ut one case when herniorrhaphy was performed during simultaneous operations . Results Mean hospital stay after surgery was 1.5 days (range 3 hours-14 days), No p erioperative deaths occurred in this series. General complications were one case of acute intestinal bleeding and two cases of urinary retention. Loca l complications consisted of eight (5.5%) minor complications and one case of orchitis (0.7%) followed by testicular atrophy. In no instance was posto perative neuralgia or chronic pain reported. Two re-recurrences occurred. Conclusions Given the low complication rate in this and other reported series and the a bsence of surgical or general complications described after preperitoneal o pen or laparoscopic repair and after general and spinal anesthesia, anterio r mesh repair under local anesthesia seems to be a low-cost surgical techni que that can be safely and effectively used even in a teaching hospital for the treatment of the majority of patients with recurrent groin hernias.