{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:16:07Z","timestamp":1778156167895,"version":"3.51.4"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hernia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>There are no randomized controlled trials comparing general anesthesia (GA) to local anesthesia with monitored anesthesia care (LA\u2009+\u2009MAC) for adult patients undergoing elective umbilical hernia repair (UHR). We hypothesized that LA\u2009+\u2009MAC would be associated with fewer postoperative complications without increasing recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2009+\u2009MAC. Variables significant on univariable analysis were included in a propensity score\u2013matched analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 602 patients underwent UHR with GA (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009427) or LA\u2009+\u2009MAC (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009175). PSMA yielded 143 patients in the GA and 175 patients in the LA\u2009+\u2009MAC group. In the unmatched cohort, recurrence was higher after GA than LA\u2009+\u2009MAC (4.7% vs. 1.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), but this difference was not significant after matching (2.8% vs. 1.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.30). Overall, 58 complications occurred (54 GA vs. 4 LA\u2009+\u2009MAC). In the unmatched cohort, complication rates were higher with GA (12.6% vs. 2.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), and this difference persisted after matching (9.8% vs. 2.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Operative room time was modestly shorter with LA\u2009+\u2009MAC (mean difference\u2009=\u20095.3\u00a0min).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LA\u2009+\u2009MAC was associated with significantly fewer postoperative complications and modestly shorter operative time, without increased recurrence. These findings support consideration of LA\u2009+\u2009MAC for elective open UHR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10029-026-03704-9","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T11:45:01Z","timestamp":1778154301000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of general anesthesia vs. local anesthesia with monitored anesthesia care for elective umbilical hernia repair in adults: a propensity score- matched analysis"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7720-419X","authenticated-orcid":false,"given":"Sergio","family":"Huerta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Crystal","family":"Phung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jared","family":"McAllister","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sri","family":"Tummala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirling","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"3704_CR1","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1177\/0003134820951452","volume":"88","author":"L Loss","year":"2022","unstructured":"Loss L, Meier J, Phung T, Ordonez J, Huerta S (2022) Feasibility of umbilical hernia repair under local anesthesia and monitored anesthesia care at a Veteran Affairs hospital. Am Surg 88:167\u2013173. https:\/\/doi.org\/10.1177\/0003134820951452","journal-title":"Am Surg"},{"key":"3704_CR2","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.amjsurg.2015.03.014","volume":"211","author":"JJ Yao","year":"2016","unstructured":"Yao JJ, Pham T, El Mokdad A, Huerta S (2016) Predictors of recurrence of umbilical hernias following primary tissue repair in obese veterans. Am J Surg 211:18\u201323. https:\/\/doi.org\/10.1016\/j.amjsurg.2015.03.014","journal-title":"Am J Surg"},{"key":"3704_CR3","doi-asserted-by":"publisher","unstructured":"Huerta S, McAllister J, Phung C, Guzzetta AA (2025) Elective umbilical hernia repair in adults in the 21st century: challenging the status quo. J Clin Med 14(Article number pending). https:\/\/doi.org\/10.3390\/jcm1417XXXX. verify at proof stage","DOI":"10.3390\/jcm1417XXXX"},{"key":"3704_CR4","doi-asserted-by":"publisher","first-page":"e220","DOI":"10.1177\/000313482008600421","volume":"86","author":"J Meier","year":"2020","unstructured":"Meier J, Huerta S (2020) Primary repair of umbilical hernias: evidence of feasibility. Am Surg 86:e220 (DOI not indexed)","journal-title":"Am Surg"},{"key":"3704_CR5","doi-asserted-by":"publisher","first-page":"884","DOI":"10.1016\/j.surg.2019.09.007","volume":"167","author":"J Meier","year":"2020","unstructured":"Meier J, Huerta S (2020) Primary repair of umbilical hernias is feasible independent of patient\/hernia size. Surgery 167:884\u2013885. https:\/\/doi.org\/10.1016\/j.surg.2019.09.007","journal-title":"Surgery"},{"key":"3704_CR6","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1007\/s10029-017-1577-z","volume":"21","author":"A Jairam","year":"2017","unstructured":"Jairam A, Kaufmann R, Muysoms F, Jeekel J, Lange J (2017) The feasibility of local anesthesia for the surgical treatment of umbilical hernia: a systematic review of the literature. Hernia 21:223\u2013231. https:\/\/doi.org\/10.1007\/s10029-017-1577-z","journal-title":"Hernia"},{"key":"3704_CR7","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1186\/s12893-025-02129-0","volume":"25","author":"S Michael","year":"2025","unstructured":"Michael S, Naseer A, Tarazi M, Vadhwana B (2025) The feasibility and safety of ventral hernia repairs under local anaesthesia: a systematic review. BMC Surg 25:229. https:\/\/doi.org\/10.1186\/s12893-025-02129-0","journal-title":"BMC Surg"},{"key":"3704_CR8","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.jss.2021.04.006","volume":"266","author":"J Meier","year":"2021","unstructured":"Meier J, Berger M, Hogan TP, Reisch J, Cullum CM, Lee SC, Skinner CS, Zeh H, Brown CJ, Balentine CJ (2021) Local anesthesia is associated with fewer complications in umbilical hernia repair in frail veterans. J Surg Res 266:88\u201395. https:\/\/doi.org\/10.1016\/j.jss.2021.04.006","journal-title":"J Surg Res"},{"key":"3704_CR9","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1001\/jamaoncol.2018.0231","volume":"4","author":"PM Polanco","year":"2018","unstructured":"Polanco PM, Mokdad AA, Zhu H, Choti MA, Huerta S (2018) Association of adjuvant chemotherapy with overall survival in patients with rectal cancer and pathologic complete response following neoadjuvant chemotherapy and resection. 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Hernia 27:201\u2013202. https:\/\/doi.org\/10.1007\/s10029-022-02666-4","journal-title":"Hernia"}],"container-title":["Hernia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10029-026-03704-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10029-026-03704-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10029-026-03704-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T11:45:02Z","timestamp":1778154302000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10029-026-03704-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3704"],"URL":"https:\/\/doi.org\/10.1007\/s10029-026-03704-9","relation":{},"ISSN":["1248-9204"],"issn-type":[{"value":"1248-9204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]},"assertion":[{"value":"20 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institution and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Appropriate Institutional Review Board approval was obtained for the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}},{"value":"Informed consent was waved by the Institutional Review Board at our Institution.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interests or non-financial interests in the subject matter or materials discussed in this manuscript.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"None of the authors have any interests to disclose.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"Approval for this study was obtained from the Institutional Review Board (IRB) of the VA North Texas Health Care System (VANTHCS). Because all data analyzed were retrospective and de-identified, the requirement for informed consent was waived by the VANTHCS IRB.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Institutional Review Board statement"}},{"value":"This article does not contain any study of animals performed by the authors.","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal rights"}}],"article-number":"196"}}