L. Loss1, J. Meier2,3, S. Huerta2,3 1University Of Toledo Medical Center,College Of Medicine And Life Sciences,Toledo, OH, USA 2University Of Texas Southwestern Medical Center,Department Of Surgery,Dallas, TX, USA 3VA North Texas Health Care System,Department Of Surgery,Dallas, TX, USA
Introduction:
Umbilical hernia (UH) repair is a common surgical procedure. Surgical repair typically utilizes mesh, laparoscopy, and general anesthesia (GA). We hypothesize that open umbilical hernia tissue repair (OUHTR) under local anesthesia (LA) has comparable outcomes to similar patients undergoing open repair with GA.
Methods:
From 2015 to 2019, 438 umbilical hernias have been repaired at our institution by the same surgeon, utilizing a standardized technique in veteran patients. Open, primary, elective, tissue repair UHs were included in this analysis (n= 324). Since 2017, 15% (n=49) UH have been repaired under LA. We compared outcomes and operative times between GA vs. LA in patients undergoing OUHTR. Univariable analysis was performed by Student’s T-Test and X2/Fisher’s exact test for continuous and categorical variables respectively. Multivariable analysis was performed to determine independent predictors of complications.
Results:
Patients undergoing OUHTR with GA and LA had similar age (56.3±11.9 vs. 56.5±13.0 years.; p=0.89) and BMI (32.4±4.7 vs. 31.6±4.1 Kg/m2; p=0.21). The GA cohort was a lesser ASA class (2.6±0.6 vs. 2.8±0.5; p=0.05), had bigger hernia size (2.5±1.2 vs. 2.8 cm; p=0.02), and were less likely to have a chronically incarcerated hernia (18.0% vs. 37%; p=0.004). Complications within 30 days was zero in patients undergoing LA vs. 2.0% with GA (p=0.03). Arrival to OR to the beginning of the operation, skin-to-skin OR time, and time of the end of the operation to out of the OR were all reduced in patients undergoing LA (overall OR time was reduced by 25.1 min; all p’s <0.05). None of the patients with LA required post anesthesia care unit for recovery. Univariable analysis showed that complications were associated with hernia size, longer skin-to-skin time, and repair under GA, none of these factors were independent predictors of complication on logistic regression analysis. All patients undergoing LA (100%) reported being comfortable during the operation, the worst pain was 2.1±1.0 (out of 10), and all (100%) would undergo LA if they had to do it again.
Conclusion:
LA for OUHTR was associated with less complications, reduced operative room times while maintaining excellent patient satisfaction. LA for UHR should be more widely utilized.