Factors Influencing Development of Subcutaneous Carbon Dioxide Emphysema in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair

摘要

Background: There is a paucity of published data on the incidence of subcutaneous emphysemanand the causative factors responsible for its occurrence during laparoscopic procedures. This studynwas undertaken to evaluate the incidence and factors associated with the occurrence of subcutaneousnemphysema in patients undergoing a laparoscopic totally extraperitoneal (TEP) inguinal hernianrepair.nMaterials and Methods: The prospective study included 100 patients who presented with a primaryninguinal hernia and underwent an elective laparoscopic TEP hernia repair from Novembern2003 to May 2005. Various factors, including age, body mass index (BMI), type of hernia (i.e., unilateralnor bilateral, indirect or direct), duration of surgery, and end-tidal carbon-dioxide tensionn(start and peak), were evaluated. A grading system was evolved to document clinically apparentnsubcutaneous emphysema immediately and at 6 and 24 hours after the surgical procedure.nResults: A BMI u000225, longer operating time (especially u00031 hour), and higher end-tidal carbondioxidentension (start, peak, and difference) were found to be significantly associated with the developmentnof subcutaneous emphysema. Age and type of hernia—unilateral versus bilateral, directnversus indirect—were not found to be statistically significant factors.nConclusions: The incidence of subcutaneous emphysema in laparoscopic extraperitoneal hernianrepairs is high and largely under-reported. Once it is noted, the progression of the surgical emphysemanduring this type of surgery can have serious complications (e.g., cardiovascular and hemodynamicndisturbances) unless timely, appropriate measures are taken. Etiology of subcutaneousnemphysema is multifactorial, with no single factor having a prominent association.