Sanjay P, Woodward A
Department of Surgery, Ninewells Hospital and Medical School, Dundee, UK.
Ann R Coll Surg Engl. 2007 Jul;89(5):497-503. doi: 10.1308/003588407X202056.
Specialist hernia centres and public hospitals with a dedicated hernia service (Plymouth Hernia Service) have achieved remarkable results for inguinal hernia repair with the use of local anaesthesia and set the standards for groin hernia surgery. There is minimal data in the literature as to whether such results are reproducible in the National Health Service in the UK.
A retrospective analysis of all inguinal hernia repairs performed in one district general hospital over a 9-year period was performed. The outcome measures were type of anaesthesia used, early and late postoperative complications and recurrence. A postal questionnaire survey was conducted to obtain satisfaction rates. In addition, a postal questionnaire survey of consultant surgeons in Wales was performed to determine the use of local anaesthesia and day-case rates for inguinal hernia repair.
A total of 577 hernia repairs were performed during the study period. Of these, 369 (64%) repairs were performed under local anaesthesia (LA) and 208 (36%) under general anaesthesia (GA). Day-case repair was achieved in 70% (400) of cases. The day-case rates were significantly higher under LA compared to GA (82.6% versus 42.6%; P < 0.05). Patients operated under LA had lower postoperative analgesic requirements and lower incidence of urinary retention compared with the GA group (P < 0.05). There were 7 (1.2%) recurrences at a median follow-up of 5.1 years (range, 10.3-2.5 years). Postal questionnaire revealed higher satisfaction rates with LA compared to GA repair. Only 15% of surgeons in Wales offer the majority of their patients local anaesthetic repair.
The use of LA results in increased day-case rates, lesser postoperative analgesic requirements and fewer micturition problems. The excellent results obtained by specialist hernia centres can be reproduced by district general hospitals by increasing the use of LA to repair inguinal hernias.
专科疝气中心以及设有专门疝气服务的公立医院（普利茅斯疝气服务中心）在使用局部麻醉进行腹股沟疝修补方面取得了显著成果，并为腹股沟疝手术设定了标准。关于这些成果在英国国民医疗服务体系中是否具有可重复性，文献中的数据极少。
对一家地区综合医院在9年期间进行的所有腹股沟疝修补手术进行回顾性分析。观察指标包括所用麻醉类型、术后早期和晚期并发症以及复发情况。通过邮寄问卷调查来获取满意度。此外，对威尔士的顾问外科医生进行了邮寄问卷调查，以确定腹股沟疝修补手术中局部麻醉的使用情况和日间手术率。
在研究期间共进行了577例疝气修补手术。其中，369例（64%）手术采用局部麻醉（LA），208例（36%）采用全身麻醉（GA）。70%（400例）的病例实现了日间手术。与全身麻醉相比，局部麻醉下的日间手术率显著更高（82.6%对42.6%；P < 0.05）。与全身麻醉组相比，接受局部麻醉手术的患者术后镇痛需求更低，尿潴留发生率也更低（P < 0.05）。在中位随访5.1年（范围10.3 - 2.5年）时出现7例（1.2%）复发。邮寄问卷调查显示，与全身麻醉修补相比，患者对局部麻醉的满意度更高。威尔士只有15%的外科医生为大多数患者提供局部麻醉修补。
使用局部麻醉可提高日间手术率，减少术后镇痛需求，排尿问题也更少。地区综合医院通过增加局部麻醉在腹股沟疝修补中的使用，能够重现专科疝气中心所取得的优异成果。
