Unusual complications of laparoscopic totally extraperitoneal inguinal hernia repair

Abstract

Although complications of laparoscopic totally extraperitoneal inguinal hernia repairs are well documented, the development of pneumothorax, pneumomediastinum and subcutaneous emphysema is rarely reported. The authors' experience with a 23-year-old man who developed intraoperative bilateral pneumothoraces and cervical subcutaneous emphysema during a laparoscopic totally extraperitoneal inguinal hernia repair prompted a MEDLINE literature review. Seven similar cases were found in which the patients developed pneumothorax, pneumomediastinum and/or subcutaneous emphysema following laparoscopic hernioplasty. An intercostal catheter was inserted in two out of the seven patients only. Numerous hypotheses were proposed for the development of these complications. Several authors felt that the duration of the procedure and preperitoneal insufflation pressures are related to the development of these complications. These potentially lethal complications must be diagnosed and managed promptly.

Laparoscopic Totally Extraperitoneal Hernia Repair Versus Open Lichtenstein Hernia Repair: Results and Complications

“…This rate was comparable to those reported by other authors and confirmed the recurrence rate found in the literature. 28,29 The recurrence after the laparoscopic repair procedure occurred under the upturned edge of the lateral part of the mesh, which seems to be one of the major causes of recurrence after a TEP repair procedure. 30 At the reoperation, the recurrence found after a Lichtenstein repair procedure was noted as an indirect hernia-a possible technical error committed during that repair might have been insufficient mesh overlap of the lateral triangle of the groin and the leaving of the deep inguinal ring too loose.…”

A Contralateral Complication of Extra-peritoneal Laparoscopic Inguinal Hernia Repair

“…Common complications of TEP include recurrence, port site hernias, skin numbness, infections (wound and mesh), chronic pain, vascular and visceral injuries and migration of mesh. Less common complications including pneumothorax, pneumomediastinum, subcutaneous emphysema, mesh rejection and small bowel obstruction have also been reported (3–5). To date, there are no reported cases in the published literature of such a complication as reported here following extraperitoneal laparoscopic inguinal hernia repair.…”

Laparoscopic vs conventional tension free inguinal herniorrhaphy: 2005 Society of American Gastrointestinal Endoscopic Surgeons (SAGES) annual meeting debate

“…Complications have included major vascular injury, hollow viscus perforation, small bowel obstruction, internal hernia, bladder perforation, small bowel obstruction, visceral perforation, and trocar-site hernia [42,43]. In a metaanalysis performed by the EU Hernia Trialists Collaboration, the incidence of serious adverse events after LIH was 4.7 per 1,000 procedures, as compared with only 1.1 per 1,000 procedures for conventional herniorrhaphy [44].…”