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Open Inguinal repair with local
Anyone had local anesthesia for uncomplicated open inguinal repair? Was it hard to find a surgeon who would do it? What was your experience? Some patients have risk factors for general anesthesia that would make this a much better option.
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13 Replies
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Thanks to Bill Brown, M.D. for the clarification. At the risk of being repetitious, I cannot emphasize enough the many research articles dealing with cognitive impairment following general anesthesia. This is enough to avoid Laparoscopic methods. This is especially the case for patients already at risk for cognitive decline. Neurologists will tell you that G.A. is NOT good for the brain. In my opinion, if a surgeon is afraid to use local when the hernia is non-complicated, you should avoid that surgeon as he probably needs to take some classes in anesthesia. This assumes the patient is not overly anxious and might freak out during surgery. I had one surgeon agree to do with with G.A. backup. Once your brain goes the hernia becomes the least of your problems.
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Hi,
In all 3 of my bilateral surgeries ive had general anasthesia however at the shouldice clinic they have a rule of doing local anaesthesia for all hernias unless they have been recurrent twice. So if you’ve had surgery two times before your having to go under general. Thats how they define complicated i guess. Definitely more costly and longer recovery duration.
Baris
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@watchfulwaiting
Most hernia repairs can be done with local anesthesia and a little sedation.
But obese patients and complicated hernias usually require general anesthesia.
Laparoscopic repairs require general anesthesia.
Regards.
Bill Brown MD -
If that was the case, how do you explain the original Desarda video in which he asks the elderly patient under local to cough to test the sturdiness of his repair? Does not sound to me there is an issue with abdominal movement.
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I talked to multiple doctors who told me that they would only do my inguinal repair under general. Their reasoning was that my abdomen would still be able to flex and move while I was sedated with local, and that could be disastrous in the middle of the surgery. However, I went with Dr.Brown and it was done under local with no issues. It can definitely be done under local with a competent doctor
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I will also add there is a lot of research showing subtle brain damage from general anesthesia that is usually manifested initally as memory problems. That is a very good reason to go local.
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good intentions-interesting reply I had not thought of. Frankly I think they just are not comfortable with the patient being awake-they are not in complete control.
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General anesthesia adds cost. It’s also more dangerous. But, apparently, the medical industry is more comfortable with it now. More change.
I’m going to guess though, like Dr. Brown has pointed out in other posts, regarding injections to diagnose pain sources, that many of today’s surgeons probably don’t know how to do local anesthesia for open hernia repair. It’s probably part of the overall “division of labor” that is happening. Anesthesiologists do anesthesia and mesh surgeons implant mesh.
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I have a phobia of needles and always have problems when having injections. He told me the injections into my abdomen were quite painful. I decided on the general and had no problems. Remember i am 71 years old but fairly fit, so he foresaw no reasons not to do the general and there were none.
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Honestly I cannot think of ANY positives for general anesthesia for open uncomplicated repair. What positives did he tell you for that?
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I was given the option and discussed the pros and cons with the surgeon.
Decided on the general.
SWS -
Can anyone else confirm this? The two surgeons I had phone consults with did not want to do it. One said he would do it IF they had backup general waiting.
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Almost all open repairs are done under local anesthesia, as I understand things. All laparoscopic repairs are done under general anesthesia.
To be clear, local means that you’re awake during the surgery, and general means that you are not.
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