Oc-114 feasibility of subcutaneous onlay laparoscopic approach (scola) under local anesthesia for the patients with incisional hernia

Abstract Aim Incisional hernia is a benign disease and the indications for elective surgery are relative. Therefore, it is expected to expand the indications and improve patient quality of life by reducing invasiveness of surgery and anesthesia. We have been performing incisional hernia repair under local anesthesia for the past 12 years and report our clinical results. Material & Methods From 2009 to 2021, a consecutive group of 64 patients with incisional hernia was included. We used 0.5% lidocaine with epinephrine as local anesthesia. Pethidine was used as analgesic and dexmedetomidine as sedative. An incision of 30 mm at the top of the hernia bulge was made and a wound protector with sealing silicon cap was attached. We used three 5-mm trocars and a 5-mm flexible laparoscope. A flat self-fixating mesh with was placed over the primarily closed fascia and fixed using laparoscopic tacking devices. Results Forty-nine patients operated without endoscopy (Op). The others (n=15) required endoscopic subcutaneous dissection (LA). The mean ages of Op and LA were 66.9 and 64.3, respectively. The mean operating time of Op was significantly shorter than that of LA (100 vs 132, P=0.006). Similar hernia recurrence rete was observed (4.1% vs 6.7%, respectively). Clavien-Dindo Grade III and IV complications were not observed in both groups. Conclusions Incisional hernia repair under local anesthesia can be performed relatively safely even on elderly patients with serious co-morbidities, and the possibility of contributing to the improvement of patient quality of life by expanding the indications for surgery was expected.