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ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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vol. 12
Original paper

Spinal anesthesia is safe in laparoscopic total extraperitoneal inguinal hernia repair. A retrospective clinical trial

Dogan Yildirim, Adnan Hut, Sinan Uzman, Ahmet Kocakusak, Suleyman Demiryas, Mikail Cakir, Cihad Tatar

Videosurgery Miniinv 2017; 12 (4): 417–427
Online publish date: 2017/12/29
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Introduction: Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is an effective and safe method for the treatment of inguinal hernia. There are very few studies on regional anesthesia methods in TEP surgery.

Aim: To compare TEP inguinal hernia repair performed when the patient was treated under spinal anesthesia (SA) with that performed under general anesthesia (GA).

Material and methods: All total of 80 patients were studied between December 2015 and March 2017. Hyperbaric bupivacaine and fentanyl were used for SA, to achieve a sensorial level of T3. Propofol, sevoflurane, rocuronium, fentanyl, and tracheal intubation were used for GA. Intraoperative events related to SA, surgical times, intra- and postoperative complications, and pain scores were recorded.

Results: The mean operative time in the SA TEP group was 70.2 ±6.7 min, which was significantly longer than the mean operative time in the GA TEP group of 67.2 ±6.2 min (p < 0.038). The mean pain scores in the SA TEP group were 0.23 ±0.42 at the first hour, 1.83 ±0.64 at 6 h and 1.28 ±0.45 at 24 h. These scores were significantly lower than the corresponding scores of 5.18 ±0.84 (p < 0.001), 2.50 ±0.55 (p < 0.001) and 1.58 ±0.55 in the GA TEP group. Generally, patients were more satisfied with SA than GA (p < 0.004).

Conclusions: Spinal anesthesia TEP is significantly less painful in the early postoperative period, leading to earlier ambulation than GA TEP. Additionally, SA TEP results in significantly less need for analgesics and better patient satisfaction results. SA TEP seems to be a better alternative than the existing GA TEP.

general anesthesia, spinal anesthesia, laparoscopic repair

Bassini E. Nuovo metodo sulla cura radicale dell’ernia inguinale. Arch Soc Ital Chir 1887; 4: 380.
[No authors listed] Laparoscopic versus open repair of groin hernia: a randomized comparison. The MRC Laparoscopic Groin Hernia Trial Group. Lancet 1999; 354: 185-90.
Neumayer L, Giobbie-Hurder A, Jonasson O. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004; 350: 1819-27.
National Institute for Clinical Excellence. Guidance on the use of laparoscopic surgery for inguinal hernia, technological appraisal guidance 2001; No. 18. NICE, London.
Mathavan VK, Arregui ME. The SAGES Manual of Hernia Repair. Fixation versus no fixation in laparoscopic TEP and TAPP. Springer; New York 2013; 203-12.
Belyansky I, Tsirline VB, Klima DA et al. Prospective, comparative study of postoperative quality of life in TEP, TAPP, and modified Lichtenstein repairs. Ann Surg 2011; 254: 709-14.
McCormick K, Scott NW, Go PM, et al. Hernia Trialists Collaboration. Laparoscopic technique versus open technique for inguinal hernia repair. Cochrane Database Syst Rev 2003; 1: CD001785.
Swanstrom L. Laparoscopic surgery: laparoscopic herniorrhaphy. Surg Clin North Am 1996; 73: 483-91.
Lau H, Wong C, Chu K, Patil NG. Endoscopic totally extraperitoneal inguinal hernioplasty under spinal anesthesia. J Laparoendosc Adv Surg Tech A 2005; 15: 121-4.
Sinha R, Gurwara AK, Gupta SC. Laparoscopic total extraperitoneal inguinal hernia repair under spinal anesthesia: a study of 480 patients. J Laparoendosc Adv Surg Tech A 2008; 18: 673-7.
Molinelli BM, Tagliavia A, Bernstein D. Total extraperitoneal preperitoneal laparoscopic hernia repair using spinal anesthesia. JSLS 2006; 10: 341-4.
Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The tension-free hernioplasty. Am J Surg 1989; 157: 188-93.
Takata MC, Duh QY. Laparoscopic inguinal hernia repair. Surg Clin North Am 2008; 88: 157-78.
Sinha R, Gurwara AK, Gupta SC. Laparoscopic total extraperitoneal inguinal hernia repair under spinal anesthesia: a study of 480 patients. J Laparoendosc Adv Surg Tech A 2008; 18: 673-7.
Felix EL, Harbertson N, Vartanian S. Laparoscopic hernioplasty: significant complications. Surg Endosc 1999; 13: 328-31.
Bringman S, Blomqvist P. Intestinal obstruction after inguinal and femoral hernia repair: a study of 33, 275 operations during 1992–2000 in Sweden. Hernia 2005; 9: 178-83.
Krishna A, Misra MC, Bansal VK, et al. Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc 2012; 26: 639-49.
Donmez T, Erdem VM, Sunamak O, et al. Laparoscopic total extraperitoneal repair under spinal anesthesia versus general anesthesia: a randomized prospective study. Ther Clin Risk Manag 2016; 12: 1599-608.
Wake BL, McCormack K, Fraser C, et al. Transabdominal pre-peritoneal (TAPP) vs. totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev 2005; 1: CD004703.
Lau H, Lee F. Seroma following endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 2003; 17: 1773-7.
Vărcuş F, Duţă C, Dobrescu A, et al. Laparoscopic repair of inguinal hernia TEP versus TAPP. Chirurgia (Bucur) 2016; 111: 308-12.
Reiner MA, Bresnahan ER. Laparoscopic total extraperitoneal hernia repair outcomes. JSLS 2016; 20. pii: e2016.00043.
Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 2011; 25: 2773-843.
Tamme C, Scheidbach H, Hampe C, et al. Totally extraperitoneal endoscopic inguinal hernia repair (TEP). Surg Endosc 2003; 17: 190-5.
Sung TY, Kim MS, Cho CK, et al. Clinical effects of intrathecal fentanyl on shoulder tip pain in laparoscopic total extraperitoneal inguinal hernia repair under spinal anaesthesia: a double-blind, prospective, randomized controlled trial. J Int Med Res 2013; 41: 1160-70.
Spivak H, Nudelman I, Fuco V, et al. Laparoscopic extraperitoneal inguinal hernia repair with spinal anesthesia and nitrous oxide insufflation. Surg Endosc 1999; 13: 1026-9.
Sarli L, Costi R, Sansebastiano G, et al. Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg 2000; 87: 1161-5.
Kojima Y, Yokota S, Ina H. Shoulder pain after gynaecological laparoscopy caused by arm abduction. Eur J Anaesthesiol 2004; 21: 578-9.
Donmez T, Erdem VM, Uzman S, et al. Laparoscopic cholecystectomy under spinal-epidural anesthesia vs. general anaesthesia: a prospective randomised study. Ann Surg Treat Res 2017; 92: 136-42.
Bhatia T, Bhatia J, Attri JP, et al. Intrathecal dextmedetomidine to reduce shoulder tip pain in laparoscopic cholecystectomies under spinal anesthesia. Anesth Essays Res 2015; 9: 320-5.
Lau H, Patil NG. Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty: multivariate analysis of predictive factors. Surg Endosc 2004; 18: 92-6.
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