title: Laparoscopic extraperitoneal inguinal hernia repair with spinal anesthesia and nitrous oxide insufflation.
abstract: BACKGROUND
  Laparoscopic repair of inguinal hernia is traditionally performed under general anesthesia mainly because of the adverse effects that carbon dioxide pneumoperitoneum has on awake patients. Since a mandatory use of general anesthesia for all hernia repairs is questionable, the feasibility of laparoscopic extraperitoneal herniorraphy using spinal anesthesia combined with nitrous oxide insufflation was investigated.
  
  
  METHODS
  Over a 4-month period, February to May 1998, we performed 35 consecutive total extraperitoneal inguinal hernia procedures (24 unilateral, 11 bilateral) using spinal anesthesia and nitrous oxide extraperitoneal gas. Data on operative findings, self-reported operative and postoperative pain and discomfort (visual analog pain scale), procedure-related hemodynamics, and complications were collected prospectively.
  
  
  RESULTS
  All 35 procedures were completed laparoscopically without the need to convert to general anesthesia. Mean operative time was 39 +/- 7 min for unilateral hernia and 65 +/- 10 min for bilateral hernia. Incidental peritoneal tears occurred in 22 patients (63%) resulting in nitrous oxide pneumoperitoneum, which was well tolerated. The patients remained hemodynamically stable throughout the procedure, and operative conditions and visibility were excellent. Complications at a mean of 4 months after the procedure included seven uninfected seromas (20%), three patients with transient testicular pain, and one (3%) recurrence.
  
  
  CONCLUSIONS
  Laparoscopic total extraperitoneal hernia repair can be safely and comfortably performed using spinal anesthesia with extraperitoneal nitrous oxide insufflation gas. This method provides a good alternative to general anesthesia.
authors.affiliation: Department of Surgery, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel 49100, USA.
authors.forename: H
authors.initials: H
authors.lastname: Spivak
authors.forename: I
authors.initials: I
authors.lastname: Nudelman
authors.forename: V
authors.initials: V
authors.lastname: Fuco
authors.forename: M
authors.initials: M
authors.lastname: Rubin
authors.forename: P
authors.initials: P
authors.lastname: Raz
authors.forename: A
authors.initials: A
authors.lastname: Peri
authors.forename: S
authors.initials: S
authors.lastname: Lelcuk
authors.forename: L A
authors.initials: LA
authors.lastname: Eidelman
mesh_terms: D000368:Aged; D018712:Analgesics, Non-Narcotic; D000775:Anesthesia, Spinal; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide; D011028:Pneumoperitoneum, Artificial
chemical_list: D018712:Analgesics, Non-Narcotic; D009609:Nitrous Oxide