Transinguinal preperitoneal patch (TIPP) under local anesthesia with sedation.

Transinguinal preperitoneal placement of the patch (TIPP) combines the advantages of the preperitoneal patch and the simplicity of the inguinal approach. The aim of the study was to evaluate the feasibility of TIPP under local anesthesia (LA) with sedation on a series of unselected patients. All 161 patients referred to one of us for inguinal hernia repair were included in a prospective evaluation; they were operated on for 169 inguinal hernias, in LA with sedation. TIPP was the routine method and was used in all but a few particular cases. TIPP was performed in 139 cases out of 169 (82.2%). In 21 cases (12.4%) another method was chosen, due to the patient's age, the patient's request, or the type of the hernia. In nine cases (5.3%) another technique was used because preperitoneal dissection was not possible, due to a previous preperitoneal surgery. In the 139 cases where a TIPP was performed, general anesthesia was used in four cases at the patient's request and spinal anesthesia in two cases of large irreducible scrotal hernias in old, frail patients. TIPP was begun under LA in 133 cases and conversion to general anesthesia was necessary in one case only. Therefore, TIPP under LA was possible in 132 cases out of 139 (95%). These results suggest that TIPP can be performed under LA in most cases. The expected advantages of combining preperitoneal patch repair and local anesthesia are worth being confirmed by comparative studies.