LAPAROSCOPIC LIGATION OF BILATERAL SPERMATIC VARICES UNDER EPIDURAL-ANESTHESIA

Feasibility and safety of laparoscopic ligation of bilateral internal spermatic varices under epidural anesthesia were assessed in 11 patien ts. Another 11 patients undergoing the same procedure under ventilatio n-assisted anesthesia served as controls. Patients in both groups belo nged to the American Society of Anesthesia functional class I. Arteria l blood analyses were obtained (1) in the horizontal supine position; (2) in the 15 degrees Trendelenburg position; (3) at 15 min after carb on dioxide pneumoperitoneum insufflation, and (4) at 15 min after desu fflation in the supine position. In the epidural anesthesia group, art erial blood parameters and respiratory rate remained stable in the Tre ndelenburg position. After intraperitoneal insufflation of carbon diox ide for 15 min, the arterial carbon dioxide level increased from 40.1/-2.2 to 42.1+/-2.6 mm Hg, the respiratory rate increased from 17.0+/- 1.4 to 20.6+/-1.2/min, the blood pH value decreased from 7.386+/-0.027 to 7.355+/-0.034, all values showing statistically significant differ ences. These changes returned to the preinsufflation level 15 min afte r release of the pneumoperitoneum. The above-mentioned parameters rema ined unchanged under the pneumoperitoneum by assisted ventilation in t he control group. The mean time of surgery was similar in both groups: 82 and 90 min for the groups having general and epidural anesthesia, respectively. All laparoscopic procedures were accomplished successful ly under general anesthesia. However, failure to ligate the internal s permatic varices occurred in 3 patients under epidural anesthesia, mai nly due to patient intolerance to abdominal distension. The operation was continued under intubated general. anesthesia for relaxing the abd ominal muscle to provide an adequate working space. In 8 patients bein g successfully operated under epidural anesthesia, 5 experienced mild but tolerable abdominal distension; 2 complained of shoulder pain intr aoperatively. Although laparoscopic ligation of internal spermatic var ices could be accomplished in some patients under epidural anesthesia, it carried a high failure rate, more intraoperative morbidity, and si gnificant arterial blood gas alterations. Routine ventilation-assisted anesthesia is suggested for therapeutic laparoscopy even for an easy procedure such as the ligation of the internal spermatic varices.