[Laparoscopic treatment of ventral hernia under spinal anesthesia]
Daniel Bejarano González-Serna1, Antonio Utrera, José Ignacio Gallego
1Servicio de Cirugía General, Hospital Juan Ramón Jiménez, Huelva, España. danielbejarano@terra.es
Introduction:
Laparoscopic surgery is usually performed with the patient under general anesthesia. In open surgery, regional anesthesia has been found to have fewer adverse effects than general anesthesia. We studied whether spinal anesthesia is feasible in laparoscopic ventral hernia repair.
Patients And Method:
Bupivacaine and fentanyl were administered to obtain T2 block; midazolam was used for sedation. Patients underwent laparoscopic intraperitoneal hernia repair using an ePTFE prosthesis fixed with a double crown technique. An intra-abdominal pressure of 12 mmHg and low-flow insufflation (1.5 L/minute) were used for pneumoperitoneum.
Results:
Nineteen out of 23 patients underwent laparoscopic ventral hernia repair under spinal anesthesia; conversion to open surgery or general anesthesia was required in four patients. Additional sedation successfully relieved pain in patients with abdominal and shoulder discomfort (10.5%). Hypotension occurred in 68% of patients but was easily resolved by fluid administration.
Conclusions:
Spinal anesthesia is feasible and well tolerated in laparoscopic hernia repair. Studies comparing spinal and general anesthesia in this field are warranted.
