Laparoscopic intraperitoneal onlay polytetrafluoroethylene mesh repair (IPOM) for inguinal hernia during spinal anesthesia in patients with severe medical conditions
J. Schmidt et al., Laparoscopic intraperitoneal onlay polytetrafluoroethylene mesh repair (IPOM) for inguinal hernia during spinal anesthesia in patients with severe medical conditions, SURG LA E P, 11(1), 2001, pp. 34-37
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 hern
ia during spinal anesthesia in patients with chronic obstructive pulmonary
disease. Spinal anesthesia was performed using hyperbaric bupivacaine (3-3.
5 mt) injected at L2-L3. if necessary, additive opioid therapy was administ
ered. Under low-pressure pneumoperitoneum (10 mm Hg), polytetrafluoroethyle
ne mesh was stapled securely on the posterior inguinal wall to spare epigas
tric and iliac vessels. Fifteen patients underwent surgery. Median age was
62 years. All patients were classified American Society of Anesthesiologist
s 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 sho
w recurrence or infection. This technique is an effective method of repair
of inguinal hernia in patients with severe chronic obstructive pulmonary di
sease, and it provides a maximum of comfort.