Laparoscopic total extraperitoneal hernia repair under regional anesthesia: a systematic review of the literature

Abstract

Spinal anesthesia for total extraperitoneal inguinal hernia repair seems safe and feasible. However, more well-designed randomized clinical studies are required to determine the safety as well as the advantages and disadvantages of regional anesthesia in TEP hernia repair in different population groups before this method can be adopted into routine daily clinical practice.

Comparison of General, Epidural, and Spinal Anesthesia in Laparoscopic TEP (Total Extraperitoneal Repair) for Inguinal Hernia

“…In 3 metaanalysis studies, the risk of having headache was found to be higher in the SA group compared with the GA group. 7,8,21,23 In our study, significantly higher rates of headaches were detected in EA (6.8%) and SA (11.4%) groups compared with GA (0%) groups. In 2 meta-analyses, the incidence of urinary retention was higher in SA compared with GA. 8,23 In the study comparing EA and GA, 24 urinary retention was detected in 1 patient (3.3%) in the EA group, but there was no significant difference between the 2 groups.…”

“…In the literature, to prevent hypotension, it is recommended to hydrate patients before surgery, establishing pneumoperitoneum at lower pressures, tilting the operating table, and finally administering appropriate medication. 7 During our study, most of the hypotension complaints observed in the patients were corrected with intravenous fluid given during surgery. In a small number of patients, their hypotension improved without any additional intervention in clinical follow-up.…”

“…3 Although GA is most commonly preferred in TEP operations there have been studies conducted with SA or EA in recent years. 7,8 In laparoscopic hernia repairs, GA is preferred more for reasons such as patients demand full analgesia in order to be "completely unconscious" and because the TEP procedure is considered easier to teach, learn and perform under GA, with a faster learning curve. 18 Surgeons are often concerned that adequate muscle relaxation cannot be achieved to create sufficient extraperitoneal space opening under regional anesthesia for TEP surgeries.…”

Prophylactic Administration of Alpha Blocker for the Prevention of Urinary Retention in Males Undergoing Inguinal Hernia Repair Under Spinal Anesthesia: Interim Analysis of a Randomized Controlled Trial

“…The latter has been also confirmed in a previous study from our group, where 32% of patients under spinal anesthesia developed POUR [4]. However, despite these, spinal anesthesia, still, remains an attractive option for IH repair [5], since regional anesthesia is associated with favorable results in terms of hypotension, postoperative nausea, vomiting, and pain [3,6].…”

Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in patients with liver cirrhosis accompanied by ascites

“…Meantime, TEP is less influenced by intraabdominal conditions because the procedure avoids entering into peritoneal cavity, such as peritoneal adhesion. [20–22] But TEP may be associated with a high risk of extraperitoneal hematoma, collections in the Retzius space. In this retrospective study, all TEP repair was successfully performed and without conversion to TAPP or open repair, but peritoneum rupture occurred in 4 patients.…”