Surgical audit of inguinal hernia surgery under local anaesthesia at a district hospital set up in central India


  • Anurag Jain Department of General surgery, Government Medical College, Ratlam, Madhya Pradesh, India
  • Rajiv Jain Department of General surgery, Sri Aurobindo Institute of Medical Sciences and Research Centre, Indore, Madhya Pradesh, India
  • Hariom Gupta Department of Orthopaedics, District Hospital, Sehore, Madhya Pradesh, India



Inguinal hernia, Lichenstein tension free repair, Lidocaine, Bupivacaine


Background: This article outlines the results of audit for feasibility and reliability of use of local anaesthesia as a routine practice in inguinal hernia surgery in an Indian district hospital setup. Through this prospective study an effort have been made to analyse practicability of local anaesthesia for inguinal hernia surgery in terms of cost effectiveness, minimizing recovery period, and reducing routine case load on hospitals with a goal to provide health for all, in a set up where patient load outnumber resources both in expertise and facilities.

Methods: A prospective analysis and auditing of 120 patients with unilateral inguinal hernia who underwent inguinal hernia surgery by Lichtenstein tension free mesh repair under local anaesthesia at Sehore district hospital during the study period was done. The primary outcomes of the study were analysed on grounds of cost benefit, patient satisfaction levels, complications such as infection, haematoma, chronic pain, and recurrence.

Results: The mean age of patients in present study was 44.23 years (20-76 years). The mean operating time was 70 minutes (40-90). The mean post operative room stay was 3.3 hours (2-6 hours). Intraoperatively 30 patients (25%) had problems such as pain, bradycardia/tachycardia, hypotension, perspiration. Recurrance was observed in 1 patient (0.83%) during the mean follow-up of 3.6 months (1-6 months).

Conclusions: In hernia repairs local anaesthetic is reliable, easy, safe and cost effective technique and its use can dramatically reduce waiting period for operation in planned surgeries.

Author Biography

Anurag Jain, Department of General surgery, Government Medical College, Ratlam, Madhya Pradesh, India

department of surgery

assistant professor general surgery


Read RC. The development of inguinal herniorrhaphy. Surg Clin North Am. 1984;64(2):185-96.

Eubanks WS. Hernia. In: Sabiston Textbook of Surgery 16e. 16 edn. Edited by CMT. Philadelphia, Pennsylvania. W.B. Saunders Company;2001: 198.

Patino J. A history of the treatment of hernia. In:Hernia 5th edn. Edited by Nyhus LM CR. Philadelphia: Lippincott;2002: 17-28.

Hair A, Duffy L, McLean J, Taylor S, Smith H, Walker A, et al. Groin hernia repair in Scotland. Br J Surg. 2000;87:1722–6.

Horlocker TT. Peripheral nerve blocks- regional anesthesiafor the new millennium. Reg Anesth Pain Med. 1998;23:237-40.

Saber A, Ellabban GM, Gad M, Elsayem K. Open preperitoneal versus anterior approach for recurrent inguinal hernia: A randomized study. BMC Surg. 2012;12:22.

Nordin P, Zetterstrom H, Gunnarsson U, Nilsson E. Local regional or general anaesthesia in groin hernia repairs;multicentre randomized trail. Lancet. 2003;362:853-7.

Baskerville PA, Jarrett PEM. Day care inguinal hernia repair under local anaesthesia. Ann R Coll Surg Engl. 1983;65:224-5.

Kulacoglu H, Ozyaylali I, Yazicioqlu D. Factors determining the dose of local anesthetic agent in unilateral inguinal hernia repair. Hernia. 2009;13(5):511-6.

Van Veen RN, Mahabier C, Dawson I, Hop WC, Kok NF, Lange JF, et al. Spinal or local anaesthesia in Lichtenstein hernia repair:a randomized controlled trail. Ann Surg. 2008;247(3):428-33.

Young DV. Comparison of local, spinal and general anesthesia for inguinal herniorrhaphy. Am J Surg. 1987;153:560-3.

Seker G, Kulacoglu H. The Acceptance rate of local anesthesia for elective inguinal hernia repair among the surgeons working in a teaching hospital. JCPSP Pak. 2012;22(2):126-7.

Ozgun H, Kurt MN, Kurt I, Cevikel MH. Comparison of local, spinal, and general anaesthesia for inguinal herniorraphy. Eur J Surg. 2002;168:455-9.

Callese T, Inguinal hernia repair: anaesthesia, pain and convalescence. Dan Med Bull 2003;50;203-18.

Gonulla NN, Cubukcu A, Alponat A. Comprarison of local and general anaesthesia in tension free (Lichtenstein) hernioplasty: a prospective randomized trial. Hernia. 2002;6:29.

Ozgun H, Kurt MN, Kurt I, Cevikel MH. Comparison of local,spinal,and general anaesthesia for inguinal herniorraphy. Eur J Surg. 2002;168:455-9.

Ball EL, Sanjay P. Woodward A. Comparison of buffered and unbuffered local anaesthesia for inguinal hernia repair – a prospective study. Hernia. 2006;10:175–8.

Song D, Greilich NB, White PF, Watcha MF, Tongier WK. Recovery profiles and costs of anaesthesia for out patients unilateral inguinal herniorrhaphy. Anesth Analg. 2000;91:876–81.

Teasdale C, McCrum A, Williams NB, Horton RE. A randomised controlled trial to compare local and general anaesthesia for short stay inguinal hernia repair. Ann R Coll Surg Engl. 1982;64: 238–42.

Young DV. Comparison of local, spinal and general anaesthesia for inguinal herniorrhaphy. Am J Surg. 1987;153:560–3.

Pieper C, Tons C, Schippers E, Busch F, Schumpelick V. Local versus general anaesthesia for Shouldice repair of inguinal hernia. World J Surg. 1994;18:912–6.

Jensen P, Mikkelsen T, Kehlet H. Post herniorrhaphy urinary retention – effect of local, regional and general anaesthesia. Reg Anaesth Pain Med. 2002;27:612–7.

Bendavid R. Complications of groin hernia surgery. Surg Clin North Am. 1998;78(6):1089-103.






Original Research Articles