Laparoscopic Inguinal Hernia Repair Under Spinal Anesthesia
*Meagan Derbyshire, *Heather Grant, *Antonio Lam, *Victoria Pepper, *Gregory Banever, *David Tashjian, *Kevin Moriarty, Michael Tirabassi
Baystate Medical Center, Springfield, MA
Objective: Evaluate the safety and cost of laparoscopic inguinal hernia repair compared to open inguinal hernia repair in infants under spinal anesthesia.
Design: Retrospective cohort study.
Setting: Tertiary care center, with ambulatory and hospitalized population.
Patients: All infants <6-months underdoing inguinal hernia (n=226). Genders, gestational age, and age at time of surgery were similar between groups.
Interventions: Choice of anesthetic and surgical approach.
Main Outcome Measures: OR time, cost and post-operative outcomes.
Results: 54%(122/226) of patients underwent general anesthesia, while 46%(104/226) spinal. For cases under general, 72%(88/122) were open (OG) and 28%(34/122) laparoscopic (LG). For cases under spinal, 79%(82/104) were open (OS) and 21%(22/104) laparoscopic (LS).Median procedure times in minutes: LG 52, LS 38, OS 42, and OG 60 (p<0.05). Median costs: LG $5586, LS $4307, OS $3825, and OG $4879 (p<0.05). As compared to general anesthesia, spinal anesthetic was associated with a shorter procedure time and lower cost. These differences were significant for both unilateral and bilateral hernia repair by Kruskall-Wallis test. Complications included: LG 1 bleeding event and 1 recurrent hernia; LS 1 recurrent hernia; OS 1 wound infection; OG 2 wound infections and 1 apnea/bradycardia event within 24-hours of anesthesia. Additionally, 11 patients required metachronous hernia repair (4.5%), of which 85% occurred in open approach. Median follow-up was 43.4 months.
Conclusions: Laparoscopic inguinal hernia repair can be safely performed in infants under spinal anesthesia without significant compromise of early perioperative outcomes. Advantages may include shorter procedure time and lower cost.
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