Ambulatory Epigastric Hernia Repair Using Local Anaesthesia: A Pragmatic Approach In A Resource Poor Society.

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