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

BACKGROUND: General anesthesia has been used as a standard for laparoscopic inguinal hernia repair including both techniques (Trans-Abdominal Pre-Peritoneal repair and the Total Extra-Peritoneal repair), while regional anesthesia has been occasionally applied in high risk patients where general anesthesia is contraindicated. In case of the total extraperitoneal repair (TEP), several authors have attempted to perform TEP repair under regional anesthesia and reported on the safety and feasibility of this procedure.

METHODS: The present review was conducted according to the PRISMA guidelines. Outcome parameters where patients and hernia characteristics, characteristics of anesthesia and surgery procedure, perioperative complications, length of hospital stay, follow up duration.

RESULTS: Eight studies on 1287 male and 24 female patients underwent laparoscopic TEP under spinal anesthesia were systematically analyzed. The most common anesthetic agent used, was bupivacaine 0,5%. The conversion rate to general anesthesia, due to anesthesia failure was 0.76% and the rate of conversion to open procedure was 0.2%. The most common intraoperative incidence was hypotension which was successfully managed with the appropriate medical intervention. Seroma was the most common postoperative complication regarding the procedure. The estimation of overall mean length of stay was 1.56 days.

CONCLUSIONS: 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.