title: Abdominal wall lifting with spinal anesthesia vs pneumoperitoneum with general anesthesia for laparoscopic herniorrhaphy.
abstract: BACKGROUND
  Laparoscopic herniorrhaphy has generally been very successful since any postoperative inguinal pain or tension is considerably less troublesome than after other open methods. The conventional laparoscopic approach in the treatment of inguinal hernia involves the use of pneumoperitoneum and general anesthesia. Nevertheless, some complications can be encountered and the procedure is costly. We, therefore, examined the possibility of using a more practical and cost efficient method.
  
  
  METHODS
  Based on our findings, we propose the use of a Kirschner lifting wire as a means of separating the abdominal wall during laparoscopic herniorrhaphy. Two Kirschner wires are introduced through the subcutaneous tissue, between the umbilicus and inguinal ligament, and parallel to the inguinal ligament. Furthermore, we recommend the use of spinal anesthesia as a means by which the problems associated with general anesthesia and the potential cardiopulmonary complications of carbon dioxide insufflation, are circumvented. Fifteen cases of inguinal hernia have been treated with this new method and compared to the more conventional procedure of pneumoperitoneum under general anesthesia.
  
  
  RESULTS
  Visibility of the operative field when used in the inguinal region was not limited at all, and Kirschner wire is considerably less expensive. The postoperative course for the patients who were operated by the new method was uneventful.
  
  
  CONCLUSIONS
  Our results indicate that this new method can be useful for the treatment of inguinal hernia.
authors.affiliation: First Department of Surgery, Kurume University School of Medicine, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Ohta
authors.forename: I
authors.initials: I
authors.lastname: Kodama
authors.forename: Y
authors.initials: Y
authors.lastname: Yamauchi
authors.forename: J
authors.initials: J
authors.lastname: Takeda
authors.forename: M
authors.initials: M
authors.lastname: Noutomi
authors.forename: T
authors.initials: T
authors.lastname: Suematsu
authors.forename: K
authors.initials: K
authors.lastname: Shirouzu
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D003362:Cost-Benefit Analysis; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D011183:Postoperative Complications