Laparoscopic intraperitoneal onlay polytetrafluoroethylene mesh repair (IPOM) for inguinal hernia during spinal anesthesia in patients with severe medical conditions.

摘要

In patients with severe pulmonary disease, laparoscopic techniques are not advised. The authors report their preliminary experience with laparoscopic intraperitoneal onlay polytetrafluoroethylene mesh repair for inguinal hernia during spinal anesthesia in patients with chronic obstructive pulmonary disease. Spinal anesthesia was performed using hyperbaric bupivacaine (3-3.5 mL) injected at L2-L3. If necessary, additive opioid therapy was administered. Under low-pressure pneumoperitoneum (10 mm Hg), polytetrafluoroethylene mesh was stapled securely on the posterior inguinal wall to spare epigastric and iliac vessels. Fifteen patients underwent surgery. Median age was 62 years. All patients were classified American Society of Anesthesiologists physical status III/IV. Mean forced expiratory volume in the first second was 1.1 L/s. Median operating time was 20 minutes. Postoperative recovery was uneventful for all patients. The average duration of hospital stay was 1.5 days. Seroma or hematoma was not noted. Six-month follow-up did not show recurrence or infection. This technique is an effective method of repair of inguinal hernia in patients with severe chronic obstructive pulmonary disease, and it provides a maximum of comfort.