End-Tidal CO2 During Enhanced-View Totally Extraperitoneal Hernia Repair: A Comparison of Retrorectus and Intraperitoneal Insufflation

Ashley Huggins, Cameron Casson, Bradley Kushner, Manjaap Sidhu, Arnab Majumder, Sara E. Holden, Jeffrey Blatnik

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Although the enhanced-view totally extraperitoneal (eTEP) approach has demonstrated safety, efficacy, and durability for small- to medium-sized hernia repairs, the relationships between retrorectus insufflation, intraoperative respiratory stability, and end-tidal CO2 (ETCO2) levels has not been appraised. Methods: We conducted a retrospective chart review of patients undergoing elective robotic-assisted ventral hernia repairs at our quaternary academic center from July 2018 through December 2021. Patients were grouped by repair technique, either eTEP or robotic transversus abdominis release (r-TAR). Baseline demographics, intraoperative anesthesia records, and perioperative outcomes were reviewed. Anesthesia data were collected at intubation and 30-min time intervals thereafter. Operative time, length of stay, patient-controlled anesthesia use, and perioperative complications were compared. Results: In total, 205 patients underwent an eTEP repair and 97 patients underwent an r-TAR repair. Intraoperatively, eTEP repairs had significantly higher ETCO2 at the beginning of the case (times 1-4, P < 0.05), and a higher peak ETCO2 (P < 0.05) when compared to r-TAR repairs. This difference in ETCO2 desisted as the case progressed, with a subsequent increase in respiratory rate (times 2-6, P < 0.05) in the eTEP procedures. The eTEP group demonstrated significantly shorter operative times, decreased patient-controlled anesthesia use, and a shorter length of stay. There was no significant difference in postoperative intensive care unit admission or respiratory distress. Conclusions: This study demonstrates that retrorectus insufflation during eTEP hernia repairs correlated with higher levels of ETCO2 compared to r-TAR repairs yet was not associated with any meaningful difference in perioperative outcomes. Communication of these respiratory differences with anesthesia is needed for proper ventilation adjustments.

Original languageEnglish
Pages (from-to)857-864
Number of pages8
JournalJournal of Surgical Research
Volume302
DOIs
StatePublished - Oct 2024

Keywords

  • Abdominal wall reconstruction
  • Extraperitoneal
  • Minimally invasive surgery
  • Retrorectus insufflation
  • Robotics
  • Ventral hernia

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