Comparison of intraocular pressure during laparoscopic totally extraperitoneal (TEP) versus transabdominal preperitoneal (TAPP) inguinal hernia repair.

Abstract

Laparoscopic totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair are standard laparoscopic procedures for inguinal hernia repair. Some evidence has shown that pneumoperitoneum can cause an increase in intraocular pressure (IOP) during surgery. This study aimed to compare intraoperative IOP following extraperitoneal CO2 insufflation with the TEP approach and intraperitoneal CO2 insufflation with the TAPP approach. This study is a prospective cohort study. Patients who had inguinal hernias suitable for laparoscopic inguinal hernia repair were assigned to undergo the TEP or TAPP approach. We measured preoperative, intraoperative, and postoperative IOP. The IOP of the TEP and TAPP groups was evaluated using a t test. The relations between peak inspiratory pressure (PIP), mean arterial pressure (MAP), and end-tidal CO2 (EtCO2) were estimated using ANOVA. Univariate and multivariate analyses were performed to determine the factors associated with IOP. There were 50 patients in this study (TEP group n = 25, TAPP group n = 25). The change in intraoperative IOP from the preoperative measurement to the measurement after CO2 insufflation was not statistically significant in either the TEP or TAPP group (p value = 0.357). There was no significant difference in intraoperative IOP change between the TEP and TAPP groups. Intraoperative MAP and PIP were related to IOP, but intraoperative EtCO2 was not. There was no significant intraoperative IOP change during laparoscopic inguinal hernia repair. Both the TEP and TAPP techniques can be performed safely without increasing intraoperative IOP.