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Transabdominal preperitoneal laparoscopic inguinal herniorrhaphy (TPLIH) under regional anaesthesia
G Fierro1, M Sanfilippo, V D'Andrea
1Department of Anesthesiology and Intensive Care, University La Sapienza, Rome, Italy.
Background:
In an attempt to investigate whether laparoscopy really is a major advance in the treatment of inguinal hernia, the authors performed laparoscopic transabdominal preperitoneal inguinal herniorrhaphy under regional anaesthesia in 15 consecutive patients, 7 of whom with severe medical conditions contraindicating general anaesthesia.
Methods:
In the first 5 patients (Group 1) an epidural anaesthesia was performed, whereas in the following 10 patients (Group 2), fentanyl was added to the epidural anaesthesia, and bupivacaine was administered into the subarachnoid space.
Results:
Results from Group 1 were poorer than those obtained in Group 2. All patients complained of shoulder pain and discomfort which required the intraoperative administration of analgesics in 7 patients and conversion to open repair in one patient.
Conclusions:
Although laparoscopy is a feasible and effective procedure in repairing inguinal hernias, it is not indicated in high-risk patients who can be safely, effectively, and less expensively treated with open tension-free repair techniques under local anaesthesia.