Laparoscopic ventral hernia repair under spinal anesthesia: a feasibility study

Abstract 

Background

Regional anesthesia has not been used as the sole anesthetic procedure in laparoscopic ventral hernia repair due to the fear of potential adverse effects of the pneumoperitoneum. However, there are recent reports on the feasibility of performing laparoscopic procedures, such as cholecystectomy, in fit patients, under spinal anesthesia alone. The current study aimed to detect the feasibility of performing laparoscopic ventral hernia repair under spinal anesthesia.

Methods

Twenty-five American Society of Anesthesiologists (ASA) I or II patients underwent laparoscopic ventral hernia repair with low-pressure CO₂ pneumoperitoneum under spinal anesthesia. In 9 cases the hernia was umbilical/para-umbilical, in 5 cases epigastric, and in 11 cases incisional. Intraoperative incidents, complications, postoperative pain, and recovery in general, as well as patient satisfaction at follow-up examination, were prospectively recorded.

Results

All operations were completed laparoscopically and conversion from spinal to general anesthesia was not required in any of the cases. Median pain score at 4 hours postoperatively was .5 (range 0–5), at 8 hours 1.5 (range 0–6), and at 24 hours 1.5 (range 0–4). Most patients were discharged 24 hours after the operation; the median hospital stay was 1 day (range 1–3 days). At 2-weeks follow-up, no late complications were detected and all patients reported being satisfied with the anesthetic procedure.

Conclusion

Laparoscopic ventral hernia repair with low-pressure CO₂ pneumoperitoneum can be successfully and safely performed under spinal anesthesia. Furthermore, it seems that spinal anesthesia is associated with minimal postoperative pain and smooth recovery.

Keywords: Laparoscopy, Ventral hernia, Mesh repair, Spinal anesthesia