Abstract
Introduction Minimally invasive surgery (i.e., laparoscopy) and minimally invasive anesthesia
(i.e., caudal anesthesia with spontaneous respiration) have separately shown benefits
for inguinal hernia repair in infants, yet to what degree these techniques can be
combined remains unknown. This study investigated whether laparoscopy impacts the
feasibility of performing caudal anesthesia with spontaneous respiration in infants.
Methods Prospectively collected data of all infants less than 12 months old and over 3 kg
weight who underwent laparoscopic indirect hernia repair (LAP) at our department from
2019 to 2021 were compared with a historical control-matched group of infants who
underwent open repair (OPEN) from 2017 to 2021. We assessed the patients' characteristics,
anesthesia, and surgical data as well as intra- and postoperative complications.
Results A total of 87 infants were included (LAP n = 29, OPEN n = 58). Caudal anesthesia with spontaneous respiration was feasible in 62.1% of cases
(LAP n = 55.2%, OPEN n = 65.5%; nonsignificant). Neither group registered anesthetic intra- or postoperative
complications. Sedatives were utilized in 97% of LAP patients versus 56.9% of OPEN
patients (p < 0.00001). The airway was secured with a laryngeal mask in 89.7% of patients during
LAP versus 41.4% during OPEN (p < 0.00001). No significant differences were found regarding the use frequency of
opioids (48.3% LAP vs. 34.5% OPEN; nonsignificant) or neuromuscular blockers (6.9%
LAP vs. 5.2% OPEN; nonsignificant).
Conclusion This is the first comparative study on caudal anesthesia and spontaneous respiration
in infants undergoing laparoscopic versus open inguinal hernia surgery. Laparoscopy
increased the need for ventilatory support and sedatives but did not significantly
impair the feasibility of caudal anesthesia and spontaneous respiration.
Keywords
laparoscopic inguinal hernia repair - infants - caudal anesthesia - spontaneous respiration
- minimally invasive surgery
