Percutaneous ilioinguinal-iliohypogastric nerve block or step-by-step local infiltration anesthesia for inguinal hernia repair: what cadaveric dissection says? / 대한외과학회지

PURPOSE: The repair of groin hernias with local anesthesia has gained popularity. Two main methods have been described for local anesthesia. This study was aimed at comparing percutaneous truncular ilioinguinal-iliohypogastric block and step-by-step infiltration technique by using cadaver dissections. METHODS: The study was performed on an adult male cadaver by using blue dye injection. A percutaneous nerve block simulation was done on right side and the dye was given in between the internal oblique and transversus muscles. On the left side, a skin incision was deepened and the dye was injected under the external oblique aponeurosis. Following the injections, stained areas were investigated superficially and within the deeper tissues with dissection. RESULTS: There was a complete superficial staining covering the iliohypogastric and ilioinguinal nerves in the inguinal floor at both sides. On the right side, intraabdominal observation showed a wide and intense peritoneal staining, while almost no staining was seen on the left side. Preperitoneal dissection displayed a massive staining including testicular vascular pedicule and vas deferens on the right side. The dye solution also infiltrated the area of the femoral nerve prominently. On the contrary, a very limited staining was seen on the left. CONCLUSION: It may not always be easy to keep the percutaneous block within optimum anatomical limits without causing adverse events. A step-by-step infiltration technique under direct surgical vision seems to be safer than percutaneous inguinal block for patients undergoing inguinal hernia repair.

questionnaire study on the surgeon's preferences for inguinal hernia repair after a decade

During the 20th century, hernia repair trend changed several times. A very interesting competition has been going on between the opponents of Lichtenstein and laparoscopic repairs. We recently questioned the same issue by the same method to see if laparoscopic hernia repair found more opponents and preference rate in surgeons and physicians in Ankara, Turkey. In general 88.9% of the respondents preferred open repair, while only 11.1% chose laparoscopy. The majority of the participants who preferred an open repair stated that it was a better known technique to choice. Almost half considered local anaesthesia an advantage. Laparoscopic repair was mainly preferred for its advantages of less pain and early return to work. When three consecutive surveys among the same population in Ankara in 1997, 2001 and 2007 were compared the laparoscopic repair preference rates did not show a statistical difference [9.1%, 16.1% and 11.1% respectively]