Early outcome and feasibility of ambulatory inguinal herniorrhaphy in single institute

Abstract

Introduction: Inguinal hernia is one of common surgical diseases in Thailand and conventionally treated by in-patient surgery department. Because the surgery is performed under spinal anesthesia, it requires two overnight hospital stays. While, ambulatory or one-day herniorrhaphy has been shown to be an alternative standard approach in other institutes over two decades and has gained more recognition as it provides the same result with less resource used. The author aimed to evaluate the practicality of this surgical method in the institutes. Objective: This study intended to determine the success rate and feasibility of ambulatory or day-case hernia surgery at Phramongkutklao Hospital. The Lichtenstein repair under local anesthesia (ambulatory group) was compared to the conventional approach (control group) which is a repair under spinal or general anesthesia. Materials and methods: This study was designed as a prospective cohort study by enrollment of all patients with unilateral inguinal hernia who obtained surgery between October 2018 and April 2019. The inclusion criteria were adult patients with Nyhus classification 1-3B with voluntary consent that were purposive sampling assigned to either ambulatory or conventional groups by surgeon preference technique. Ambulatory hernia protocol is composed of preemptive pain control, local inguinal nerve block, optional deep sedation, and post anesthetic discharge score (PADS) evaluation before discharge. The pre-determined PADS score higher than 9 was the criteria for hospital discharge. Outcome variables included duration of surgery, early postoperative complication, hospital cost, resumed normal activities, and 30-day complication. Results: The ambulatory group was composed of 29/125 patients (23.2%), of which 93.1% of this group were discharged within the same day. Failure of two cases were caused by a low PADS score and an asthmatic attack with necessitated overnight observation. Compare to the conventional group, the ambulatory group, who are younger (p = 0.012), had shorter operative time (75 vs 90 mins, p = 0.005), and had faster resumed daily activities (5 vs 7 days, p < 0.001), were observed without significant differences in early complication and hospital cost. Conclusion: This study was an evidence to prove that inguinal herniorrhaphy performed on one-day technique is as safe and effective as conventional spinal anesthesia technique.