Effects of persistent CO(2) insufflation during different laparoscopic inguinal hernioplasty: a prospective, randomized, controlled study.

Objective: The aims of this study were to investigate the effects of carbon-dioxide (CO(2)) insufflation on hemodynamic and respiratory function during laparoscopic inguinal hernioplasty and to evaluate the safety of transabdominal preperitoneal hernia repair (TAPP) and extraperitoneal hernia repair (TEP).

Methods: Forty patients with inguinal hernia were admitted for laparoscopic inguinal hernia repair in our study. The patients were randomly assigned to undergo TAPP (TAPP group, n = 20) or TEP (TEP group, n = 20). Hemodynamic and respiratory parameters, including heart rate, blood pressure, end-tidal CO(2) (EtCO(2)), and blood-gas parameters, were observed and compared between the two groups.

Results: There was no significant difference between the two groups in terms of sex, age, American Society of Anesthesiology degree, body-mass index, type of hernia, operation time, hospital stay, and postoperative pain score. In both groups, 5 minutes into the operation, blood pressure, EtCO(2), PaCO(2), and HCO(3)(-) increased significantly, whereas heart rate and pH decreased significantly (P < 0.05). The above tendency became significant with the operation prolonged. All parameters recovered to normal levels at the end of surgery. No significant difference was found between the TAPP and TEP groups.

Conclusions: Both TAPP and TEP procedures can result in CO(2) accumulation, acidosis, increased blood pressure, and decreased heart rate. But, these effects were transient and could be well controlled by appropriate treatments during the operation. The laparoscopic TAPP and TEP techniques are safe for patients by proper perioperative management.