Local Anesthesia Safe and Effective for Small Ventral Hernia Repairs, suggests study

Ventral hernias contribute significantly to surgical workload globally, burdening health systems heavily. Historically, repair has been undertaken under general anaesthesia (GA), which is more risky particularly in older or medically complicated patients. This systematic review sought to establish whether local anaesthesia might offer an acceptable alternative. An extensive literature search including all publications from 1966 to 2023 using OVID® EMBASE and MEDLINE was carried out. Thirty-three studies were finally incorporated, with emphasis placed on hernia type, rates of complications, LA methods, length of hospital stay, and general cost-effectiveness. Notably, studies dealing only with inguinal hernias were omitted in order to keep ventral hernia repairs in focus.

The review evaluated outcomes from 33 published studies, a total of 13,491 patients who received ventral hernia repair under LA. Variables considered were rates of complication, recurrence, postoperative pain, early mobilisation, patient satisfaction, and discharge time. The ROBINS-I instrument was applied for quality assessment of the non-randomised studies. The study intentionally omitted inguinal hernias to focus the analysis exclusively on other abdominal wall hernias, so results are directly relevant to the particular research question.

Key Findings

• Of the 13,491 patients, complication rates were extremely low. Hematomas and wound infections varied between a low of 0.3% and 2%.

• Recurrence rates were similarly low, from 0.3% to 2.5%.

• One of the most notable findings was that over 97% of the patients were walking within hours of surgery.

• The majority of patients were considered candidates for same-day discharge, freeing up the hospital beds and conserving funds.

• Post-operative pain was low, and this contributed to extremely high rates of patient satisfaction of 90–97%.

• Local anaesthesia was particularly beneficial in patients who were elderly and frail, who in general have more risks during general anaesthesia.

• These favourable outcomes were largely seen in patients with hernia defects < 5 cm, and thus defect size would appear to be a primary determinant of LA suitability.

• However, the review also identified heterogeneity in study design, small numbers, and a lack of standardisation between studies in the administration of LA.

This systematic review strongly supports the application of local anaesthesia for repair of ventral hernias in cases with small defects (<5 cm). The procedure was safe, feasible, and very acceptable to patients, especially those of advanced surgical risk. With complication and recurrence less than 2.5%, and over 97% of patients ambulating within a few hours of surgery, LA repairs present a useful and cost-saving alternative to conventional methods. Wider adoption, steered by standardized procedures, has the potential to bring about improved patient outcomes and alleviate the strain on healthcare systems worldwide.

Reference:

Michael, S., Naseer, A., Tarazi, M. et al. The feasibility and safety of ventral hernia repairs under local anaesthesia: a systematic review. BMC Surg 25, 229 (2025). https://doi.org/10.1186/s12893-025-02931-8