title: Laparoscopic transabdominal preperitoneal repair of inguinal hernia under spinal anesthesia: a pilot study.
abstract: BACKGROUND
  The laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is an evolving technique associated with the well-known advantages of a minimally invasive approach. However, general anesthesia is routinely required for the procedure. Based on our previous experience in regional anesthesia for laparoscopic procedures, we designed a pilot study to assess the feasibility and safety of performing laparoscopic TAPP repair under spinal anesthesia.
  
  
  METHODS
  Forty-five American Society of Anesthesiologists I or II patients with a total of 50 inguinal hernias underwent TAPP repair under spinal anesthesia, using a low-pressure CO(2) pneumoperitoneum. Five patients had bilateral hernias, and 4 patients had recurrent hernias. Thirty hernias were indirect and the remaining direct. Intraoperative incidents, postoperative pain complications, and recovery in general as well as patient satisfaction at the follow-up examination were prospectively recorded.
  
  
  RESULTS
  There was 1 conversion from spinal to general anesthesia and 2 conversions from laparoscopic to the open procedure at a median operative time of 50 minutes (range 30-130). Ten patients complained of shoulder pain during the procedure, and 6 patients suffered hypotension intraoperatively. The median pain score (visual analog scale) was 1 (0-5) at 4 hours after the completion of the procedure, 1.5 (0-6) at 8 hours, and 1.5 (0-5) at 24 hours, and the median hospital stay was 1 day (range 1-2). Sixteen patients had urinary retention requiring instant catheterization. At a median follow-up of 20 months (range 10 months-28 months), no recurrence was detected.
  
  
  CONCLUSIONS
  TAPP repair is feasible and safe under spinal anesthesia. However, it seems to be associated with a high incidence of urinary retention. Further studies are required to validate this technique.
authors.affiliation: Department of Surgery, University Hospital of Larissa, Larissa, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Zacharoulis
authors.forename: Frank
authors.initials: F
authors.lastname: Fafoulakis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Baloyiannis
authors.forename: Eleni
authors.initials: E
authors.lastname: Sioka
authors.forename: Stavroula
authors.initials: S
authors.lastname: Georgopoulou
authors.forename: Costas
authors.initials: C
authors.lastname: Pratsas
authors.forename: Eleni
authors.initials: E
authors.lastname: Hantzi
authors.forename: George
authors.initials: G
authors.lastname: Tzovaras
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal; D005240:Feasibility Studies; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain; D017060:Patient Satisfaction; D010537:Peritoneum; D010865:Pilot Projects; D011028:Pneumoperitoneum, Artificial; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome