Laparoscopic totally extraperitoneal inguinal hernia repair under epidural anesthesia
F Varcus, C Tarta, C Duta, M Papurica, Adina Coman, F Lazar
University of Medicine and Pharmacy Victor Babes Timisoara
Second Surgical Clinic of Timisoara County Hospital
Introduction:Laparoscopic total extraperitoneal (TEP) inguinal hernia repair has proved efficacy, causes less postoperative pain, better cosmetic results and earlier return to work. One important obstacle to the widespread acceptance of TEP is the requirement for general anesthesia (GA). In our study we assessed the practice of the TEP under epidural anesthesia.
Results:In all 26 cases operation started with epidural anesthesia, but 5 (19,2%) of them were converted to GA; the other 21 (80,8%) were realized only under epidural anesthesia. All cases were successfully completed laparoscopically and there were no conversions to classical procedures. The conversions to GA was done because of the accidentaly pneumoperitoneum (with subsequent shoulder-tip pain), wich require the mechanical ventilation for the management of hypercapneea. There were no intraoperative others incidents. Concerning the operative time, there was no significant difference between the cases conducted under epidural anesthesia (69.6 ± 29 min), and those converted to GA (64.3 ± 17.3 min). No straining was noticed. One patient needed further local peri-umbilical anesthesia. One patient with congenital hernia developed seroma of the scrotum treated successfully by only one ponction.
Material and Methods:Twenty six patients with unilateral inguinal hernia underwent laparocopic operation under spinal anesthesia. Hernia’s size was small, without complications. ASA risk class of the patients was I and II. The patient’s age was between 32-62 years, median age being 49 years. One 10mm trocar was placed near the omphalos, 2 others 5 mm trocars between omphalos and pubis. The operatory space was realised with the finger and the camera, without baloon.
Discussion/ Conclusion:
TEP under spinal anesthesia is fesable and save. In our experience pneumoperitoneum, with hypercapneea was the only factor who interplay leads to conversion to. A good surgical anesthesiology collaboration is necessary to obtain the good results. The option of the patient for this technique is mandatory.
comanadina February 8th, 2018
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