Evaluation of Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia Under Regional Anesthesia: A Prospective Case Series

Abstract

This study evaluated the feasibility and safety of laparoscopic total extraperitoneal (TEP) inguinal hernioplasty under regional (spinal/epidural) anesthesia, on the basis of duration of surgery, conversion to general anesthesia (GA), intra-operative and post-operative complications, post-operative hospital stay, time taken to resume normal activity and recurrence. A prospective observational study was conducted from 1st November 2014 to 31st December 2015 on a series of 33 patients with direct or indirect inguinal hernia treated in the Department of General Surgery. All the patients underwent laparoscopic TEP hernia repair under regional anesthesia and the outcome was evaluated. The study included 33 patients, 32 male and 1 female. All the patients were operated on under regional anesthesia and the operative procedure performed was laparoscopic TEP. There was no conversion of the operative procedure from TEP to the transabdominal preperitoneal (TAPP) procedure or to open hernioplasty, but conversion of regional anesthesia to GA was needed in 5 cases, because of hypotension, shoulder tip pain, pneumoperitoneum, intraoperative straining and/or inadequate preperitoneal space. A sensory level achieved after regional anesthesia below T6 was found to be a significant reason for conversion to GA. The mean post-operative hospital stay was 3.9 ± 0.9 days (range 2–6 days). The mean time taken to resume normal activity was 13.3 ± 1.8 days (range 10–15 days). TEP hernioplasty is a feasible and safe procedure which can be performed under regional anesthesia and on patients who are at high risk or unfit for GA as well as in patients with no other problems.