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Purpose <p>We aimed to develop treatment strategies for older patients with inguinal hernia considering adequate adjustment for operative risks and a comparison that accounts for differences in surgical and anesthetic approaches.</p> Methods <p>This retrospective cohort study included 1935 patients aged ≥ 80 years diagnosed with inguinal hernia at 21 facilities in Japan between January 2019 and December 2023. We compared surgical approaches performed under general anesthesia and separately analyzed anesthetic approaches in patients who underwent open surgery. Analysis was conducted using the inverse probability of treatment weighting method to adjust for confounding factors.</p> Results <p>Of the 1935 patients, 841 underwent laparoscopic surgery (LS), while 1094 underwent open surgery (OS) with general anesthesia (GA) in 373, spinal anesthesia (SA) in 401, and local anesthesia (LA) in 320. Overall postoperative complication rates of Clavien–Dindo Grade II or higher were comparable between surgical approaches under GA (LS: 3.8% vs. OS: 3.4%; risk ratio [RR]: 1.10; 95% confidence interval [CI]: 0.57, 2.10). Comparisons of anesthetic approaches among patients with OS showed that complication rates were lower in the LA group ([LA: 1.5% vs. GA: 3.5%; RR: 0.43; 95% CI: 0.13, 1.42] and [LA: 1.1% vs. SA: 3.6%; RR: 0.29; 95% CI: 0.10, 0.90]). The LS group had a lower incidence of chronic pain than that in the OS group (LS: 1.7% vs. OS: 3.2%; RR: 0.53; 95% CI: 0.21, 1.30).</p> Conclusion <p>Laparoscopic inguinal hernia repair is a feasible option for octogenarians and nonagenarians. When general anesthesia is avoided, open surgery using local anesthesia is preferred.</p>

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Optimal surgical and anesthetic approaches for inguinal hernia repair in octogenarians and nonagenarians: a multicenter cohort study in Japan

  • 期刊论文

  • 发表日期：

    2025年4月23日

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  • Ryosuke Mizuno,
  • Shusaku Honma,
  • Kazuki Nishida,
  • Tomonori Morimoto,
  • Yuta Iwasaki,
  • Yudai Sasaki,
  • Akira Shimada,
  • Yusuke Mishima,
  • Keisuke Tanino,
  • Ryo Ataka,
  • Yuma Tanigawa,
  • Yuta Nishikawa,
  • Takahiro Suenaga,
  • Takuma Kawarabayashi,
  • Keita Hanada,
  • Shotaro Matsuda,
  • Takayuki Kawai,
  • Kaede Hirayama,
  • Masaaki Moriyama,
  • Kento Masuda,
  • Keiji Nagata,
  • Kazutaka Obama

摘要

Purpose

We aimed to develop treatment strategies for older patients with inguinal hernia considering adequate adjustment for operative risks and a comparison that accounts for differences in surgical and anesthetic approaches.

Methods

This retrospective cohort study included 1935 patients aged ≥ 80 years diagnosed with inguinal hernia at 21 facilities in Japan between January 2019 and December 2023. We compared surgical approaches performed under general anesthesia and separately analyzed anesthetic approaches in patients who underwent open surgery. Analysis was conducted using the inverse probability of treatment weighting method to adjust for confounding factors.

Results

Of the 1935 patients, 841 underwent laparoscopic surgery (LS), while 1094 underwent open surgery (OS) with general anesthesia (GA) in 373, spinal anesthesia (SA) in 401, and local anesthesia (LA) in 320. Overall postoperative complication rates of Clavien–Dindo Grade II or higher were comparable between surgical approaches under GA (LS: 3.8% vs. OS: 3.4%; risk ratio [RR]: 1.10; 95% confidence interval [CI]: 0.57, 2.10). Comparisons of anesthetic approaches among patients with OS showed that complication rates were lower in the LA group ([LA: 1.5% vs. GA: 3.5%; RR: 0.43; 95% CI: 0.13, 1.42] and [LA: 1.1% vs. SA: 3.6%; RR: 0.29; 95% CI: 0.10, 0.90]). The LS group had a lower incidence of chronic pain than that in the OS group (LS: 1.7% vs. OS: 3.2%; RR: 0.53; 95% CI: 0.21, 1.30).

Conclusion

Laparoscopic inguinal hernia repair is a feasible option for octogenarians and nonagenarians. When general anesthesia is avoided, open surgery using local anesthesia is preferred.