HERNIA REPAIR IN ELDERLY PATIENTS

Background This study evaluates a 5-year experience of the management of the most frequent abdominal wall hernias in an elderly population. Methods From April 1990 to December 1995, 231 inguinal, 12 femoral and seven umbilical hernias were repaired in 221 patients (mean age 74 (r ange 66-93) years). Concomitant diseases were present in 157 patients. A mesh repair was performed with 'tension-free' or 'plug' techniques in all but 23 inguinal and two femoral hernia repairs, in which the Ba ssini or Shouldice procedures were adopted. Ten emergency hernia repai rs were performed for strangulation. A total of 232 operations, includ ing four emergency hernia repairs, were carried out under local anaest hesia. Results There was no perioperative mortality. Acute intestinal bleeding occurred 2 days after surgery in a patient with colonic diver ticular disease. Urinary retention occurred once following emergency h ernia repair under general anaesthesia and twice after elective hernia repair under local anaesthesia. Local complications included four scr otal haematomas (2 per cent), three wound infections (1 per cent) and one case of orchitis with atrophy after repair of a recurrent hernia. There was one recurrence after a Bassini repair and one after Shouldic e inguinal herniorrhaphy. No recurrence was observed after mesh repair .Conclusion Local anaesthetic mesh hernia repair is safe and effective in elderly patients. Age should be no bar to elective hernia repair. This policy should avoid the complications of emergency operation.