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Inguinal Herniorraphy in the Elderly

Eduardo A Guzman, Frederick B Rogers
University of Vermont, Burlington, VT

Objective. Inguinal hernia repair is thought to be a relatively low morbidity operation. This study examined whether this tenet hold true in patients who are elderly with significant comorbidity.
Design. Case series. Retrospective review of a prospectively collected database.
Setting. Single surgeon practicing in Vermont over a period of 9 years.
Patients. Consecutive sample of 2145 inguinal herniorraphies in 1889 patients.
Intervention. Patients underwent an open inguinal hernia repair with mesh placement. 81% of the repairs were performed under local anesthesia with intravenous sedation.
Main Outcome Measure. Presence of comorbid conditions and complications were compared between patients younger and older than 65 years.
Results. A total of 2145 herniorraphies were performed on 1889 patients. 1646 in younger patients and 499 in older patients. Hernia repairs in older patients were more likely associated with comorbid conditions than in their younger counterparts (74% Vs 39%)(OR=4.55 p<0.0001). Specifically, hypertension (26% Vs 9%)(OR=3.5 p<0.0001), coronary artery disease (34% Vs 6%)(OR=8.4 p<0.0001) and benign prostatic hypertrophy (26% Vs 4%)(OR=8.2 p<0.0001) were more commonly present in older individuals. The commonest postoperative complications in both groups were recurrence (3%), hematoma (1%) and nerve entrapment (1%). There were no deaths. There was no significant difference in the rate of postoperative complications (6% Vs 7%)(OR=0.95, p=0.88) or recurrence rates (2% Vs 3%)(OR=0.8, p=0.65) between groups.
Conclusion. Inguinal herniorraphy under local anesthesia is a safe operation with a high success rate in the elderly. Patients with significant comorbidities are not at higher risk for complications or recurrences.

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