Abstract Aims Hernia repair under local anaesthesia (LA) has been introduced as part of a greener surgery initiative to reduce its carbon footprint. This study aims to determine the complication rate, patient satisfaction, cost and carbon footprint of hernia repairs performed under LA. Methods A retrospective cohort study of consecutive patients undergoing hernia repair under LA in a University Hospital between 06/07/2022 and 18/12/2024 was conducted. Data included patient demographics, operation details and complications. For the first 40 cases, a patient satisfaction questionnaire was obtained post-operatively. Cost (£) and carbon footprint (kilograms of C02 emitted; KgC02e) were calculated based on hospital administrative costs and Sustainable Healthcare Coalition calculators (https://shcpathways.org). Results The study included 196 patients with a median age of 64 years (range 21 to 91), 88.8% male. Hernia types included 169/196 (86.2%) inguinal, 19/196 (9.7%) umbilical, 6/196 (3.1%) femoral, and 2/196 (1.0%) ventral. On average, 32ml of LA (1:1 0.5% Bupivicaine:1% Lignocaine), 2.2mg Midazolam, and 53mcg Fentanyl were administered. The complication rate was 23/196 (11.7%), including 10/196 (5.1%) chronic pain, 6/196 (3.1%) recurrence, 4/196 (2.0%) haematoma, 2/196 (1.0%) missed femoral hernias, and 1/196 (0.5%) seroma. Consultant presence did not affect the complication rate (p=1.0). No procedures were converted to general anaesthesia (GA). Of 36/40 (90.0%) questionnaires returned, patients were satisfied with no procedural issues identified. LA resulted in a reduction of £72,008 and 3531 KgC02 compared to GA. Conclusions LA hernia repairs had acceptable complication rates, zero conversion to GA, achieved adequate patient satisfaction, and were environmentally and financially sustainable.
Zaghbour et al. (Fri,) studied this question.