Laparoscopic transabdominal preperitoneal repair of inguinal hernia under spinal anesthesia: a pilot study.
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.
Zacharoulis
Dimitris
D
Department of Surgery, University Hospital of Larissa, Larissa, Greece.
Fafoulakis
Frank
F
Baloyiannis
Ioannis
I
Sioka
Eleni
E
Georgopoulou
Stavroula
S
Pratsas
Costas
C
Hantzi
Eleni
E
Tzovaras
George
G
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