Flavio Antonio de Sá Ribeiro
Hospital Federal de Bonsucesso, Brazil
Flavio Antonio de Sa Ribeiro, 49 years old, is Headman Surgery Professor of Universidade Fundacao Serra dos Orgaos, Research Headman and Surgeon of Hospital Federal de Bonsucesso/Ministerio da Saude-Governo Federal. He is Entitled Member of Colegio Brasileiro de Cirurgioes, Doctorated in Surgery by the Universidade Federal do Rio de Janeiro, Associated Surgery Professor of Universidade Gama Filho.
Objective: To demonstrate the feasibility of inguinal hernia repair with local anesthesia in an outpatient regime, with safety, efficacy and short learning curve.
Methods: 1186 patients undergoing inguinal hernia repair under local anesthesia on an outpatient basis between November 2004 and March 2014 were prospectively evaluated. Of the total number of hernias surgically treated in this period, 755 were operated on the right, 394 on the left and 37 bilateral. Clinical, surgical and psychosocial criteria for inclusion in the procedure were used. The parameters for exclusion were complex, irreducible or recurrent hernia, obesity (BMI greater than 30 kg/m2), patient’s refusal and psychiatric disorder. All patients underwent elective surgery and were analyzed regarding surgical outcome, complications and hospital stay.
Results: All operations were completed successfully. In no case there was need to change the anesthetic method (we performed the blockage of the operative field with an anestheticsolution consisting of 0.75% ropivacaine 20 ml, 2% lidocaine 20 ml, and 0.1% adrenaline 0.4 ml and distilled sterile water 30 ml). Surgical time was similar to the one conducted with other methods of anesthesia and there were no cases of adverse effects of local anesthetics. Intra-operative complications amounted to approximately 2.64%. There was no need for hospital admissions greater than 24 hours.
Conclusion: The procedure is feasible and causes no significant perioperative pain, is safe, can be performed by residents under supervision, has satisfactory patient acceptance and complications similar to those observed in a conventional herniorhaphy, allowing lower time and cost of hospitalization and faster access to treatment.