Laparoscopic Hernia Repair Under Local Anesthesia

Norihito Wada, MD PhD, Toshiharu Furukawa, MD PhD, Yuko Kitagawa, MD PhD. Department of Surgery, School of Medicine, Keio University

Background: Laparoscopic hernia repair is considered to be a minimally invasive surgery for inguinal hernia. Pneumoperitoneum during laparoscopic surgery, however, requires muscle relaxation and general anesthesia which needs preoperative preparation and post-operative recovery process. On the other hand, open surgery with anterior approaches, such as open Lichtenstein repair, can be safely performed under local anesthesia and ensures early recovery and safety especially for patients with comorbidity. We developed a novel technique for single-incision laparoscopic totally extraperitoneal (TEP) inguinal hernioplasty feasible even under local anesthesia. Here we show the short-term outcome of this successful procedure.
Patients and Methods: From January to September 2011, a consecutive group of 28 adult patients with bilateral inguinal hernia was included in this study. Patients with obesity, inguinoscrotal hernia, irreducible hernia or coagulopathy were excluded from this study. Short-term outcomes were determined via a retrospective review of available medical records. No preoperative bowel preparation or urinary catheterization was needed. Under conscious sedation and local anesthesia, single incision of 30 mm in the lower abdomen was made and a wound protector with sealing silicon cap was placed. Two 5 mm and a 12 mm trocars were inserted. The preperitoneal space was inflated with carbon dioxide gas at 8 mmHg constant pressure. A flat self-fixating mesh with resorbable microgrip (Parietex ProGrip; Covidien, Inc., Norwalk, CT, USA) was installed through the 12 mm trocar. No tacking devices were required.
Results: The mean age was 64.4 (SD=9.6) and male sex was 95 %. Median operating time was 136 min. Intraoperative and immediate postoperative complications were not observed. Pneumoperitoneum due to peritoneal injury was occurred in 4 cases (14.3 %) and managed by inserting a flat silicon disk to keep a preperitoneal space. We observed 11 seromas (39.3 %) at 2 weeks after surgery. During median follow-up of 5 months, we had one hernia recurrence (3.6 %), in which unilateral indirect hernia was developed after direct hernia repair.
Conclusions: Short term outcomes of single-incision laparoscopic TEP inguinal hernioplasty under local anesthesia were similar to those of conventional TEP or open hernia repair. This novel procedure is a promising strategy to reduce the invasiveness of hernia repair not only surgically but also anesthesiologically.
 

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