Expert: Ronald Levy, M.D. - 3/27/2007

Question
Hi Dr. levy
I underwent open fundoplication 3 years ago. I had many complications from this surgery. I do wish I never had it. It was not good and did not work. I had a failed procedure and do not want it redone. 6 months after my first surgery, I had to have another surgery to remove my xiphoid, which was broken during my first surgery and it continually flipped up and caused extensive pain along with correcting a incisional hernia just above my navel. I now have another hernia, in the same place as the first, that is quite large 3in by 5 inches. I really do not want to have another surgery, but this one pains after sitting down for a while and then getting up, when I go to bed at night, it pains on the right side,  it also gets quite cold in this area , although the rest of my abdomen is warm. I seen a surgeon last week, and he stated that they only get larger which makes it a more difficult surgery to do and that I need to have this repaired. He stated he would have to use proplene mesh to repair this one. Same surgeon who repaired the last one. I asked him if he would repair it with a local anesthetic. He refused stating I needed a general anesthetic. I do not want to have another general anesthetic. I carry a diagnosis of MS, I have frequent runs of SVT and one short run of unsustained VT. I am waiting to have an ablation procedure done to correct these heart arrythmias. I have also had some difficulty breathing with a diagnosed mild diaphramic dysfunction.(possibally due to MS) I am awaiting more investigation on this. I am afraid to go under another general anestetic, as I awoke with a corneal abrasion, I had an allergic reaction on my abdominal incision, the broken xiphoid which I was told was a complication of this fundoplication surgery, and my health has deterioated from this first surgery. I have asked for a second opinion to see if a different surgeon would repair this with a local. My question to you is can you do a hernia repair with a local anesthetic safely. If you can perform a C-section with local and regional anesthetics why can they not repair a hernia with a local and regional anesthesia. I don't want a general anesthetic period, because of my health concerns. What are your thoughts on this? Is this just surgeon personal preference or is their logic behind telling me that I need a general to repair this. I am a 44, year old female, not overweight, no history of high blood pressure, and manage my MS quite well. I am on no prescription drugs and I am a Veterinary technician.  

Answer
You can certainly do the procedure under regional anesthesia (spinal) but not under local. The reason is that when they move the bowel around inside the hernia sac, it pulls on the mesentary which is very painful and can't be blocked by the local. Discuss this possibility with your anesthesiologist and if your surgeon still refuses, seek a second opinion.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston