Tumescent TAPP: laparoscopic inguinal hernia repair after the preperitoneal tumescent injection of diluted lidocaine and epinephrine saline solution and carbon dioxide gas

Abstract

PurposeLaparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) is technically difficult and not infrequently followed by postoperative complications and pain, especially when performed by inexperienced surgeons. To simplify TAPP and reduce postoperative pain, we devised a novel procedure whereby TAPP is carried out after the inguinal preperitoneal infiltration of diluted lidocaine and epinephrine saline solution and carbon dioxide gas (tumescent TAPP). This report introduces the concept of tumescent TAPP and summarizes its operative results.MethodsAbout 120 ml of diluted lidocaine and epinephrine solution and 60 ml of CO2 gas were infiltrated into the inguinal preperitoneal space through a transabdominal needle before TAPP. Tumescent TAPP was performed for 400 patients (355 men, 45 women; mean age, 63.2 years).ResultsUsing tumescent TAPP, we found it easier to confirm the inguinal anatomy and dissect the preperitoneal layer and inguinal floor, with less bleeding. The mean operation time was 101.9 min and there were few perioperative complications and minimal pain.ConclusionsTumescent TAPP makes conventional TAPP easier and safer; however, this procedure should be verified by a comparative study with conventional TAPP.

Risk factors for perioperative complications in inguinal hernia repair – a systematic review

“…Overall, 39 reports were found to be relevant to the research question. Of these, 3 were randomized controlled trials [11], [12], [13], 5 were prospective studies [14], [15], [16], [17], [18], 4 were case reports [10], [19], [20], [21], 25 were retrospective (registry) studies [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], and 2 were meta-analyses [47], [48].…”

“…Risk factors were identified. In addition, incidence rates were analyzed for various types of complications in 17 of the studies [11], [13], [15], [16], [18], [19], [20], [22], [24], [26], [29], [32], [36], [37], [38], [44]; if possible, the complications reported in the included studies were graded with regard to the Clavien-Dindo classification. Not all complications summarized here were reported in all of the studies.…”

Three‐step tumescent local anesthesia technique for inguinal hernia repair

“…[17][18][19][20][21] a Pubmed search (keywords: "tumescent local anesthesia" and "inguinal hernia"). [4][5][6] Our study included the largest number of patients to date and showed the effectiveness of TLA in short-and long-term outcomes.…”

“…TLA is utilized in other surgical areas; however, an appliance with inguinal hernia repair is not broadly performed. Only three English literature reports were uncovered with a Pubmed search (keywords: “tumescent local anesthesia” and “inguinal hernia”) 4–6 . Our study included the largest number of patients to date and showed the effectiveness of TLA in short‐ and long‐term outcomes.…”

Transperitoneal rectus sheath block and transversus abdominis plane block for laparoscopic inguinal hernia repair: A novel approach

“…RS and TAP blocks previously required percutaneous puncture, which carries a risk of introducing infection, causing bleeding, or damaging local structures. Recently, a percutaneous tumescent approach with diluted lidocaine and epinephrine was reported for preperitoneal dissection and local anesthesia under laparoscopic visualization . Laparoscopic visualization helps to determine anatomical structure and avoid causing damage.…”