Outcomes of general anesthesia vs. local anesthesia with monitored anesthesia care for elective umbilical hernia repair in adults: a propensity score- matched analysis.

INTRODUCTION

There 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.

METHODS

A 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.

RESULTS

A 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).

CONCLUSIONS

LA + 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.