ArticleHernia : the journal of hernias and abdominal wall surgery2026
Outcomes of general anesthesia vs. local anesthesia with monitored anesthesia care for elective umbilical hernia repair in adults: a propensity score- matched analysis.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThere are no randomized controlled trials comparing general anesthesia (GA) to local anesthesia with monitored anesthesia care (LA + MAC) for adult patients undergoing elective umbilical hernia repair (UHR). We hypothesized that LA + MAC would be associated with fewer postoperative complications without increasing recurrence.
methodsA retrospective analysis of a prospectively maintained database was performed, including consecutive Veteran patients undergoing elective open primary UHR at a single institution between August 2005 and June 2025. Patients undergoing emergent repair, laparoscopic repair, incisional hernia repair, or epigastric hernia repair were excluded. Primary outcomes were recurrence, 30-day postoperative complications, and operative room times in patients receiving GA vs. LA + MAC. Variables significant on univariable analysis were included in a propensity score-matched analysis.
resultsA total of 602 patients underwent UHR with GA (n = 427) or LA + MAC (n = 175). PSMA yielded 143 patients in the GA and 175 patients in the LA + MAC group. In the unmatched cohort, recurrence was higher after GA than LA + MAC (4.7% vs. 1.1%, p < 0.01), but this difference was not significant after matching (2.8% vs. 1.1%, p = 0.30). Overall, 58 complications occurred (54 GA vs. 4 LA + MAC). In the unmatched cohort, complication rates were higher with GA (12.6% vs. 2.3%, p < 0.01), and this difference persisted after matching (9.8% vs. 2.3%, p < 0.01). Operative room time was modestly shorter with LA + MAC (mean difference = 5.3 min).
conclusionsLA + MAC was associated with significantly fewer postoperative complications and modestly shorter operative time, without increased recurrence. These findings support consideration of LA + MAC for elective open UHR.
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