Page 34 - International guidelines for groin hernia management

Hernia

Key questions readmission following day surgery for IHs. 353 According to
a publication of outpatient surgery including groin hernia
KQ09.a Which inguinal hernias can be safely repaired in repair in more than 564,000 United States Medicare ben-
day surgery? eficiaries older than 65 years, the 7-day mortality rate was
KQ09.b Can endoscopic and open herniorrhaphies be 37 per 100,000 cases. However, there are no reports in the
performed safely in day surgery? medical literature of death or severe complications being
KQ09.c Can patients with severe comorbidities (ASA III directly related to day surgery
or higher) be safely treated in day surgery? Although open tension-free repair under local anesthetic
KQ09.d Can patients with complex inguinal hernias (e.g. seems most suitable for day surgery, published series
scrotal hernias) be safely treated in day surgery? support the use of other surgical and anesthetic techniques

Evidence in literature in this setting. Day surgery should be considered for all
Day surgery for IH repair involves patient discharge the simple inguinal herniorrhaphies (both open and endo-
same day of surgery after a period of medically supervised scopic) provided adequate aftercare is organized. 280, 353, 354
recovery. 345 However, after laparoscopic repair (TAPP/TEP) and pos-
The year 1955 marks the first publication on the terior open-mesh repair, severe pre-peritoneal or
advantages of day surgery repair of IH including: quicker retroperitoneal bleeding, may occur in rare circumstances.
mobilization, lower cost and a patient-friendly experi- In most cases, this infrequent complication occurs within
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ence. Subsequently, several retrospective case series and the first 48 h postoperatively. Since the laparoscopic
three small randomized studies were published comparing management of large hematomas is often only possible
inguinal herniorrhaphy day surgery with inpatient treat- after immediate diagnosis, short-stay treatment of these
ment. 347–350 Another randomized study surveyed patient patients can also be considered. There are no reports of
preference for site (inpatient or outpatient) of surgery. 351 Stoppa’s open pre-peritoneal approach being performed on
These studies all concluded that day surgery is cheaper outpatients.
than, and as safe and effective as, inpatient repair of There are insufficient data to routinely recommend
selected IHs. Additionally, many cohort studies exist con- outpatient repair of complex IHs (see above). However, if
cerning various other aspects of day surgery for IHs. These adequate aftercare is arranged, some of these cases may be
studies span the outpatient surgery spectrum including: suitable for ambulatory surgery.
general, regional and local anesthesia; classical operative Operations on strangulated and acutely incarcerated
techniques; open tension-free repairs; and endoscopic hernias should not be performed as day cases.
techniques. All support the notion that day surgery is a safe Barring the exclusions cited above, IH day surgery can
option for many IH patients. be considered for every patient with satisfactory care at
A 2006 Danish study of nearly 19,000 days surgery home, including stable ASA III patients. 355–359
patients noted a 0.8% hospital readmission rate. 352 A 2012 Day surgery should also be considered for the elderly,
360–362
Danish multicenter study of over 57,700 days surgeries including octogenarians. However, nonagenarians
found a 1.1% complication rate leading to hospital should be excluded since even elective IH repair in those

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