The Treatment of Inguinal Hernia in the Elderly: Under Local Anesthesia
Introduction: Inguinal hernia (IH) in the elderly is a quite common problem in general surgery. One should be aware about surgical
treatment of the cardiovascular and respiratory pathology of these patients as they are often affected. Also an important goal
of surgery is it should lead to functional recovery after the operation using the “tension free” technique and, whenever possible,
local anesthesia (LA).
Aim: Aim of this study is a better definition of the indications to surgery and anesthesia and verifying the results of surgical treatment.
Materials and Methods: From January 1999 to December 2002, our group operated 317 patients with IH; 123 patients were over 65
(119 males and 4 females, 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 operations. LA 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: LA was used in 87 patients, spinal in 31 and 5 in general; there were no post-operative deaths. Local complications
were 4 inguinal hematomas, 2 hematomas and 2 transient edemas of the scrotum, 1 wound infection, 1 seroma of the wound,
and 1 scrotal seroma (9%); all patients recovered after few days of medical therapy. No cases of ischemic orchitis occurred.
Conclusion: Inguinal herniorrhaphy can be safely performed, in elderly patients; according to personal experience, LA 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.
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