Endoscopic totally extraperitoneal inguinal hernioplasty under spinal anesthesia

Area of Science:

• Minimally Invasive Surgery
• Anesthesiology
• Hernia Repair

Background:

• Endoscopic totally extraperitoneal inguinal hernioplasty (TEP) offers superior early outcomes compared to open repair.
• General anesthesia is a concern for TEP, limiting its application in some patients.
• Literature on TEP performed under spinal anesthesia is limited.

Purpose of the Study:

• To report the early experience of performing TEP under spinal anesthesia.
• To evaluate the feasibility and outcomes of TEP in patients medically unfit for general anesthesia.

Main Methods:

• Six male patients with reducible inguinal hernias and contraindications for general anesthesia underwent attempted TEP under spinal anesthesia.
• Selection criteria included medical conditions precluding general anesthesia, such as impaired lung function.
• Patients remained conscious and communicated verbally throughout the procedures.

Main Results:

• TEP was successfully completed in 4 out of 6 patients (67%) with a mean operative time of 33 minutes.
• All successfully treated patients were asymptomatic, pain-free during the procedure, and had stable cardiorespiratory parameters.
• Conversions to open repair occurred in 2 patients due to uncooperative movement or inadequate spinal blockade. Postoperative urinary retention occurred in one patient. No seroma or recurrence was detected at mean follow-up >3 months.

Conclusions:

• TEP under spinal anesthesia is feasible in selected patients unfit for general anesthesia.
• Successful TEP under spinal anesthesia requires experienced anesthesia and surgical teams, and patient cooperation.
• This approach appears promising for selected patient populations, warranting further investigation.