Laparoscopic total extraperitoneal repair under spinal anesthesia versus general anesthesia: a randomized prospective study

Turgut Donmez,1 Vuslat Muslu Erdem,2 Oguzhan Sunamak,3 Duygu Ayfer Erdem,2 Huseyin Imam Avaroglu1 1Department of General Surgery, 2Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat State Hospital, 3Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey Background: Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-known approach to inguinal hernia repair that is usually performed under general anesthesia (GA). To date, no reports compare the efficacy of spinal anesthesia (SA) with that of GA for laparoscopic hernia repairs. The purpose of this study was to compare the surgical outcome of TEP inguinal hernia repair performed when the patient was treated under SA with that performed under GA. Materials and methods: Between July 2015 and July 2016, 50 patients were prospectively randomized to either the GA TEP group (Group I) or the SA TEP group (Group II). Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for GA. Hyperbaric bupivacaine (15 mg) and fentanyl (10 µg) were used for SA to achieve a sensorial level of T3. Intraoperative events related to SA, operative and anesthesia times, postoperative complications, and pain scores were recorded. Each patient was asked to evaluate the anesthetic technique by using a direct questionnaire filled in 3 months after the operation. Results: All the procedures were completed by the allocated method of anesthesia as there were no conversions from SA to GA. Pain was significantly less for 1 h (P<0.0001) and 4 h (P=0.002) after the procedure for the SA and GA groups, respectively. There was no difference between the two groups regarding complications, hospital stay, recovery, or surgery time. Generally, patients were more satisfied with SA than GA (P<0.020). Conclusion: TEP inguinal hernia repair can be safely performed under SA, and SA was associated with less postoperative pain, better recovery, and better patient satisfaction than GA. Keywords: spinal anesthesia, general anesthesia, TEP, inguinal herni

Fournier's gangrene: A retrospective clinical study on forty-one patients

Background: Fournier's gangrene, first described by Dr Jean Alfred Fournier in 1883, still has a high mortality rate. The prognosis and outcome of such patients were analysed

LigaSure Precise (R) use in thyroid operations: a comparison with the conventional method

Background: Most of the complications of thyroid operations are related to ligation and coagulation procedures. LigaSure(R) is an alternative method for vessel sealing and ligation and may decrease operative complications. This study analyzed the effect of LigaSure(R) use on duration of operation and on complication occurrence, compared to that of conventional methods

Open mesh and laparoscopic total extraperitoneal inguinal hernia repair under spinal and general anesthesia

Oguzhan Sunamak,1 Turgut Donmez,2 Dogan Yildirim,3 Adnan Hut,3 Vuslat Muslu Erdem,4 Duygu Ayfer Erdem,4 Ibrahim Halil Ozata,2 Mikail Cakir,3 Sinan Uzman5 1Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey; 2Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey; 3Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey; 4Department of Anesthesiology, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey; 5Department of Anesthesiology, Haseki Training and Research Hospital, Istanbul, Turkey Introduction: Mesh placement is the main standard in repair of inguinal hernia, and laparoscopic repair is the standard of care via spinal, epidural, or combined anesthesia. Here, we compared open and laparoscopic total extraperitoneal (TEP) repairs under general (GA) and spinal anesthesia (SA).Methods: Inguinal hernia patients (n=440) were analyzed retrospectively. There were four groups: Group 1 was TEP under GA (TEP-GA) (n=111); Group 2 was open mesh repair (OM) under SA (n=116) (OM-SA); Group 3 was open mesh repair under GA (n=117) (OM-GA); Group four was TEP under SA (n=96) (TEP-SA). The age, body mass index, duration of operation, hospital stay, postoperative Visual Analog Scale scores, recurrence, postoperative pain, urinary retention, headache, and patient satisfaction were all recorded.Results: There was no significant difference in terms of hypotension, vomiting, seroma and scrotal edema, recurrence, and wound infection incidence between the groups. However, the operation duration, hospital stay period, headache, urinary retention, postoperative Visual Analog Scale scores, chronic pain, and patient satisfaction showed significant differences between groups.Conclusion: Laparoscopic TEP hernia repair is a safe and effective method along with its advantages of shorter hospital stay, less recurrence, less postoperative pain, higher patient satisfaction, and similar postoperative complication rates. SA has the disadvantage of higher incidence of headache and urinary retention compared to GA. Keywords: herniorrhaphy, laparoscopy, general anesthesia, spinal anesthesi