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Ambulatory Epigastric Hernia Repair Using Local Anaesthesia: A Pragmatic Approach In A Resource Poor Society.
Agbakwuru, E.A.; Etonyeaku, A.C.; Akinkuolie, A.A.; Talabi, A.O.; Olasehinde, O.; Olekwu, A.; Ojo, A. & Akingbade, I.O.
Abstract
Background: Epigastric hernia (EH) is not uncommon in clinical practice. Repair is often
achieved using general anaesthesia (GA). We explored the tolerability and acceptability of
EH repair using local anaesthesia (LA) in our patients.
Methods: Patients with EH, seen between April, 2007 and March, 2012; who were fit for
ambulatory surgery and consented to use of LA for repair were recruited. Pentazocine or
tramadol, diazepam and 0.5% xylocaine were used. Bio data, size of fascia defect, content of
sac, and repair technique were entered into a spread sheet and was analyzed using the
SPSS 17.0.
Results: Thirty patients were treated. Eighty percent were females. Painful lump (90%) and
dyspepsia (30%) were common complaints. The mean diameter of the fascia defect was
3.3cm. The hernia sacs contained: pre-peritoneal fat (46.7%), the omentum (46.7%) or gut
(6.6%). Seventy percent, 16.7%, 10% and 3.3% had repair using simple closure, Mayo, Keel
and mesh hernioplasty techniques respectively. Early post-operative complications were
surgical site infection (3.3%), seroma (3.3%) and haematoma (6.7%). Tolerability was
excellent or good in 86.7% and the acceptance rate was 90%. Tolerability did not depend
on the duration of hernia, size of defect, or duration of surgery. No recurrence was noted
after a mean follow up period of 29.94months.
Conclusion: Ambulatory EH repair using LA is feasible and tolerable in well selected
patients. Our patients preferred it to surgery using general anaesthesia.
Keywords
hernia; epigastric; herniorraphy; local anaesthesia; ambulatory surgery
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