title: Tumescent TAPP: laparoscopic inguinal hernia repair after the preperitoneal tumescent injection of diluted lidocaine and epinephrine saline solution and carbon dioxide gas.
abstract: OBJECTIVE
  Laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) is technically difficult and not infrequently followed by postoperative complications and pain, especially when performed by inexperienced surgeons. To simplify TAPP and reduce postoperative pain, we devised a novel procedure whereby TAPP is carried out after the inguinal preperitoneal infiltration of diluted lidocaine and epinephrine saline solution and carbon dioxide gas (tumescent TAPP). This report introduces the concept of tumescent TAPP and summarizes its operative results.
  
  
  METHODS
  About 120 ml of diluted lidocaine and epinephrine solution and 60 ml of CO2gas were infiltrated into the inguinal preperitoneal space through a transabdominal needle before TAPP. Tumescent TAPP was performed for 400 patients (355 men, 45 women; mean age, 63.2 years).
  
  
  RESULTS
  Using tumescent TAPP, we found it easier to confirm the inguinal anatomy and dissect the preperitoneal layer and inguinal floor, with less bleeding. The mean operation time was 101.9 min and there were few perioperative complications and minimal pain.
  
  
  CONCLUSIONS
  Tumescent TAPP makes conventional TAPP easier and safer; however, this procedure should be verified by a comparative study with conventional TAPP.
authors.affiliation: Department of Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi Prefecture, 981-0911, Japan. h.tokumura2722@gmail.com.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Tokumura
authors.affiliation: Department of Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi Prefecture, 981-0911, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Nomura
authors.affiliation: Department of Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi Prefecture, 981-0911, Japan.
authors.forename: Fumito
authors.initials: F
authors.lastname: Saijo
authors.affiliation: Department of Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi Prefecture, 981-0911, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsumura
authors.affiliation: Department of Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi Prefecture, 981-0911, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yasumoto
authors.affiliation: Department of Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi Prefecture, 981-0911, Japan.
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Muto
authors.affiliation: Department of Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi Prefecture, 981-0911, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Katayose
authors.affiliation: Department of Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi Prefecture, 981-0911, Japan.
authors.forename: Kennichi
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi Prefecture, 981-0911, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Haneda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002245:Carbon Dioxide / Q000008:administration & dosage*; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005740:Gases; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007274:Injections, Intraperitoneal; D010535:Laparoscopy / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000517:prevention & control; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D005740:Gases; D002245:Carbon Dioxide; D012965:Sodium Chloride; D008012:Lidocaine; D004837:Epinephrine
keywords: Inguinal hernia; Tumescent laparoscopic transabdominal preperitoneal hernia repair; Tumescent local anesthesia