Laparoscopic total extraperitoneal repair under spinal anesthesia versus general anesthesia: a randomized prospective study.
BACKGROUND
Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-known approach to inguinal hernia repair that is usually performed under general anesthesia (GA). To date, no reports compare the efficacy of spinal anesthesia (SA) with that of GA for laparoscopic hernia repairs. The purpose of this study was to compare the surgical outcome of TEP inguinal hernia repair performed when the patient was treated under SA with that performed under GA.


METHODS
Between July 2015 and July 2016, 50 patients were prospectively randomized to either the GA TEP group (Group I) or the SA TEP group (Group II). Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for GA. Hyperbaric bupivacaine (15 mg) and fentanyl (10 µg) were used for SA to achieve a sensorial level of T3. Intraoperative events related to SA, operative and anesthesia times, postoperative complications, and pain scores were recorded. Each patient was asked to evaluate the anesthetic technique by using a direct questionnaire filled in 3 months after the operation.


RESULTS
All the procedures were completed by the allocated method of anesthesia as there were no conversions from SA to GA. Pain was significantly less for 1 h (P<0.0001) and 4 h (P=0.002) after the procedure for the SA and GA groups, respectively. There was no difference between the two groups regarding complications, hospital stay, recovery, or surgery time. Generally, patients were more satisfied with SA than GA (P<0.020).


CONCLUSIONS
TEP inguinal hernia repair can be safely performed under SA, and SA was associated with less postoperative pain, better recovery, and better patient satisfaction than GA.
Department of General Surgery.
Turgut
T
Donmez
Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat State Hospital.
Vuslat Muslu
VM
Erdem
Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Oguzhan
O
Sunamak
Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat State Hospital.
Duygu Ayfer
DA
Erdem
Department of General Surgery.
Huseyin Imam
HI
Avaroglu
TEP; general anesthesia; inguinal hernia; spinal anesthesia