THE EFFICACY OF EPIDURAL-ANESTHESIA FOR ENDOSCOPIC PREPERITONEAL HERNIORRHAPHY - A PROSPECTIVE-STUDY

Laparoscopic herniorrhaphy has been criticized because of the need for general anesthesia. The endoscopic preperitoneal approach allows the use of epidural anesthesia, obviating the potential complications and side effects seen with general anesthesia. The purpose of this study w as to determine the efficacy of epidural anesthesia for preperitoneal herniorrhaphy. Fifty-two patients underwent repair of a total of 80 he rnias over a 6-month period. Thirty-six patients underwent their repai rs with the use of epidural anesthesia with the goal of a T-4 sensory level. A tension-free prosthetic repair was performed in all patients. Seventeen patients had unilateral repairs and nineteen had bilateral repairs under epidural, while seven patients had unilateral repairs an d nine patients had bilateral repairs under general anesthesia. There were no significant differences in patient demographics. All herniorrh aphies were electively performed on an outpatient basis by a single su rgeon (A.L.S.) in a teaching setting. There were no significant differ ences for unilateral and bilateral repairs when type of anesthesia was compared. There was only one conversion from epidural to general anes thesia, secondary to poor sensory blockade first noticed during creati on of the preperitoneal space (97% success rate). Seven patients recei ving epidural anesthesia experienced pneumoperitoneum during the proce dure. This did not effect the ability to perform the hernia repair suc cessfully. There were no complications related to the epidural anesthe tic. Endoscopic preperitoneal herniorrhaphy can be performed effective ly under epidural anesthesia, obviating the need for general anesthesi a.