• P Chiotasso and M Ketata.
• Service de Chirurgie générale et digestive, CHU Purpan, Toulouse, France.
• Ann Chir. 1995 Jan 1;49(10):936-40.

AbstractIn patients with a large inguinal hernia, surgeons are usually reluctant to use a local anesthesia as described in the Shouldice technique. The purpose of this study was to appreciate the efficiency of such a technique. Routine local anesthesia used 200 cc of 0.5% lidocaine injected subcutaneously in the groin area and more deeply, near the anterior superior iliac spine in order to achieve a nerve block of the genital branches of the ilioinguinal and genitofemoral nerves. If necessary, the peritoneal sac is injected with lidocaine: it is usually not opened, just pushed back into the abdomen. At the end of the procedure, the estimated size of the peritoneal sac, the presence of pain, the necessity of converting the local anesthetic technique into an other procedure and the use of a prosthesis were recorded in the patient's charts. From January 1986 to December 1992, all patients with an inguinal hernia more than 6 cm in diameter, were included in the study. 111 consecutive patients were defined as having a large hernia and were operated by one of the authors. 3 patients were excluded, following general anesthesia as the first approach, males leaving 108 cases. The mean age was 59.8 years (range: 21 to 92). There were 103 males and 5 females, 60 right hernias, 37 left and 11 bilateral of which 4 were bilateral and large, giving a total of 112 large hernias. The mean diameter of the sac was 8.6 cm (range: 6 to 30). 7 patients were operated for recurrent large hernia. During the procedure, 9 patients reported pain which necessitated repeated injections of local anesthetic. The local procedure never had to be converted into general anesthesia. All patients had a Shouldice repair and none required the use of a prosthesis. Patients were reviewed after a mean of 36 months of postoperative course (from 5 to 79 months). No hernia recurrence was observed, five patients had "residual" pain.

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