Objectives: Although endoscopic totally extraperitoneal inguinal hernioplasty (TEP) confers superior
early outcomes compared to those of open repair, the requirement of general anesthesia has
been held as an argument against the application of TEP by opponents of laparoscopic surgery. To
date, the literature on TEP performed under spinal anesthesia remains scarce. The present study
reports our early experience performing TEP under spinal anesthesia in selected patients who were
medically unfit for general anesthesia.
Methods: Between March 2003 and March 2004, 6 male patients underwent attempted TEP under
spinal anesthesia. Selection criteria for the procedure included reducibility of the inguinal hernia
and concomitant medical conditions precluding general aesthesia, such as impaired lung function.
Informed consent was obtained in all patients.
Results: All patients were conscious and able to communicate verbally during the operation. TEP
was successfully completed in 4 patients, with a mean operative time of 33 minutes. All 4 patients
were asymptomatic and experienced no pain throughout the procedure. Conversion to open repair
was required in 2 patients because of uncooperative movement in one, and inadequate neural blockade
by spinal anesthesia in the other. Intraoperative cardiorespiratory parameters were stable in
all patients. Postoperative urinary retention occurred in 1 patient. The mean length of follow-up exceeded
3 months, and no seroma or recurrence was detected clinically.
Conclusion: Successful performance of TEP under spinal anesthesia requires the combined efforts
of an experienced anesthesiologist, a skilled surgeon, and a cooperative patient. Our initial experience
of TEP under spinal anesthesia appeared promising. TEP under spinal anesthesia may
have a role in selected patients who are medically unfit for general anesthesia but are otherwise
suitable for TEP.
