Walk in Walk Out Hernia Service - A New Era for Hernia Repair

Niroshini Rajaretnam and Raj Bhutiani

Department of Surgery, Derriford Hospital, UK
Department of Surgery, Northwick Park Hospital, UK

^*Correspondance to: Niroshini Rajaretnam 

 PDF  Full Text DOI: 10.25107/2474-1647.2044

Abstract

Background: Herniae cause significant morbidity which results in a reduced quality of life. Approximately 78% of surgical repairs are performed under General Anaesthesia (GA). Repair under Local Anaesthesia (LA) is more cost-effective and life-changing for an increasing number of patients who are refused surgery due to their co-morbidities. This approach is likely to become increasingly necessary as our population ages and co-morbidities rise.Methods: Retrospective analysis of a prospective database of hernia repairs performed under LA of 696 operations between May 2006 and December 2013 under supervision of a single consultant in the Walk-In-Walk-Out (WIWO) hernia service in one NHS Trust. Data collected included patient demographics, co-morbidities, operation details and complications. Cost-effectiveness analysis performed using hospital payment tariffs.Results: Of the total 696 repairs, there was zero mortality and five recorded complications. Costeffectiveness analysis showed that with open hernia repair under LA, our institution saved £411.00 per patient; £561.00 if overnight stay; and £861.00 when compared to overnight stay under GA.Conclusion: As our aging population develops co-morbidities which are high risk of morbidity/ mortality from surgery under GA, open hernia repair under LA is not only cost-effective and safe but is considered the only option. Due to present demands of offering laparoscopic surgery (only possible under GA) in training future surgeons, we feel trainees are inexperienced to manage the needs of the comorbid population unless surgical training is modified to offer operations under LA. Combining priorities of training and cost-effectiveness makes the WIWO hernia service desirable for any healthcare institution.

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Cite the article

Rajaretnam N, Bhutiani R. Walk in Walk Out Hernia Service - A New Era for Hernia Repair. Clin Surg. 2018; 3: 2044.