Tuveri Massimiliano, Calò Pietro Giorgio, Melis Giorgia, Borsezio Valentina, Muntoni Gianfranco, Medas Fabio, Tuveri Augusto, Nicolosi Angelo
Dipartimento di Chirurgia Generale e Vascolare, Clinica Sant'Elena, Quartu Sant'Elena, Cagliari.
Chir Ital. 2008 May-Jun;60(3):401-8.
The aim of this study was to describe the tension-free hernioplasty of recurrent inguinal hernia under local anaesthesia via the anterior approach, in order to evaluate the feasibility, safety and effectiveness of local anaesthesia and its outcome in terms of hernia recurrence and chronic inguinal pain. The effects of hernia type, type of anaesthesia, comorbid disease and complications on recurrence and chronic inguinal pain were analysed. Fifty-nine procedures were performed electively on 56 adult patients. Local anaesthesia was used in all patients. In 4 patients (7%) a shift from local to general anaesthesia became necessary to conclude the procedure due to intra-operative pain. Three cases (5%) with a bilateral inguinal hernia were treated at the same time. Thirty-five (59%) recurrences were repaired with the technique proposed by Lichtenstein, 13 cases (22%) with the dynamic self-regulating (P.A.D.) system, and 11 cases (19%) with a plug repair. After a median follow-up of 96 months there was only 1 recurrence (1.6%) and 1 case of chronic inguinal pain (1.6%). We conclude that use of local anaesthesia is indicated in recurrent inguinal hernia not only for its simplicity, safety and lasting postoperative analgesia, but especially for the lack of potentially detrimental cardiovascular effects observed with general anaesthesia.
本研究旨在描述局部麻醉下经前路行复发性腹股沟疝无张力修补术，以评估局部麻醉的可行性、安全性和有效性，以及其在疝复发和慢性腹股沟疼痛方面的结果。分析了疝类型、麻醉类型、合并疾病及并发症对复发和慢性腹股沟疼痛的影响。对56例成年患者进行了59例择期手术。所有患者均采用局部麻醉。4例患者（7%）因术中疼痛，手术过程中需要从局部麻醉改为全身麻醉。3例双侧腹股沟疝患者（5%）同时接受治疗。35例复发（59%）采用Lichtenstein提出的技术修补，13例（22%）采用动态自我调节（P.A.D.）系统修补，11例（19%）采用补片修补。中位随访96个月后，仅1例复发（1.6%）和1例慢性腹股沟疼痛（1.6%）。我们得出结论，复发性腹股沟疝使用局部麻醉不仅因其操作简单、安全及术后持久镇痛，尤其是因为未观察到全身麻醉可能产生的有害心血管效应。
