Anesthesia and Mesh Recommendations for Open Tension‑Free Inguinal Hernia Repair

Anesthesia Considerations

Local anesthesia for Lichtenstein repair – In patients undergoing open tension‑free inguinal hernia repair, the use of local anesthesia markedly lowers the incidence of cardiac and respiratory complications, reduces intensive‑care and overall hospital stay, and decreases overall costs when compared with general anesthesia. 1
Selective use of general anesthesia – General anesthesia should be reserved for cases where intra‑abdominal pathology (e.g., suspected bowel gangrene requiring resection or peritonitis) is present, as these situations may necessitate a more extensive operative field and airway control. 2

Synthetic polypropylene mesh in clean (CDC Class I) fields – For clean surgical fields, placement of a synthetic polypropylene mesh is recommended because it significantly lowers recurrence rates relative to tissue‑only repair without a concomitant rise in surgical‑site infection. 3