[Inguinal hernia in the elderly. Indications, techniques, results].

AIM

Inguinal hernia in the elderly is a quite common problem in general surgery. Surgical treatment must be aware of the cardiovascular and respiratory pathology these patients are often affected by and, on the other side, the goal of surgery is a quick functional recovery after the operation using the "tension free" technique and, whenever possible, local anesthesia. In this paper personal experience on inguinal hernioplasty in elderly patients (>65 years) is presented; the aim is a better definition of the indications to surgery and anesthesia and verify the results of surgical treatment.

METHODS

From January 1999 to December 2002 our group operated 317 patients with inguinal hernia; 123 patients were over 65 (119 male, 4 female, age from 65 to 101 years, mean 74); in this group 111 Lichtenstein and 12 Trabucco HPL were performed. There were 89 primitive hernias, 17 recurrences and 17 emergency operation. Local anesthesia was the method of choice except for obese patients, obstruction or strangulation, or patient's preference. In giant hernia, or when a large sac was found, the Wantz technique was performed (13 patients); a suction drainage was used if a large space in the inguinoscrotal area remained after hernia reduction (9 patients).

RESULTS

Local anesthesia was used in 87 patients, spinal in 31 and 5 in general; there were no postoperative deaths. Local complications were: 4 inguinal hematomas, 2 hematomas and 2 transient edemas of the scrotum, 1 wound infection, 1 sieroma of the wound and 1 scrotal sieroma (9%); all patients recovered after few days of medical therapy. No cases of ischemic orchitis occurred.

CONCLUSION

Inguinal herniorraphy can be safely performed, in elderly patients; according to personal experience local anesthesia proved to be a safe technique, also in patients with cardiocirculatory problems. Local complications were mild and more frequent in patients "over" 65 years (13% vs 6%, in "under" 65), but recurrent hernias make the difference; a suction drainage can reduce the problems caused by a fluid collection in the inguinoscrotal area. Wantz technique reduces the operative time and, according to personal opinion, contributed to lower ischemic testicular complications to zero.