Tabriz Navid, Uslar Verena Nicole, Cetin Timur, Marth Andreas, Weyhe Dirk
University Hospital for Visceral Surgery, Pius Hospital Oldenburg, University of Oldenburg, Oldenburg, Germany.
Department for Anesthesiology, Pius Hospital Oldenburg, Oldenburg, Germany.
Front Surg. 2021 Aug 12;8:636635. doi: 10.3389/fsurg.2021.636635. eCollection 2021.
Inguinal hernia repair is a common surgical procedure with an acceptably low complication rate. However, complications with potentially life-threating consequences may occur in rare cases. These complications might be very challenging to manage, even more in laparo-endoscopic interventions compared to open repair. One of these challenges can be the treatment of an intraoperative injury to the iliac vein. To the best of our knowledge, a lesion of the iliac vein during TEP (totally endoscopic preperitoneal) for inguinal hernia repair, and a safe technique for its management have not been reported yet. We report the case of a 75-year-old male patient with previous abdominal surgery scheduled for TEP repair of an inguinal hernia. During surgery, the iliac vein was damaged. If we had performed a laparotomy in this situation, the potentially life-threatening condition of the patient could have deteriorated further. Instead, to avoid a potential CO associated embolism, the preperitoneal pressure was gradually reduced, and the positive end expiratory pressure (PEEP) was increased in the manner that a balance between excessive bleeding and potential development of a CO embolism was achieved. The injured vein was sutured endoscopically, and in addition a hemostatic patch was applied. We then continued with the planned surgical procedure. Thrombosis of the sutured vein was prevented by prophylactic administration of low molecular weight heparin until the 14th postoperative day. We conclude that in case of major vein injury during TEP, which might happen irrespective of prior abdominal surgery, the preperitoneal pressure and PEEP adjustment can be used to handle the complication.
腹股沟疝修补术是一种常见的外科手术，并发症发生率较低，可接受。然而，在罕见情况下可能会出现具有潜在危及生命后果的并发症。这些并发症的处理可能非常具有挑战性，与开放修补相比，在腹腔镜内镜干预中更是如此。其中一个挑战可能是术中髂静脉损伤的治疗。据我们所知，尚未有关于在腹股沟疝修补的全腹腔镜腹膜前修补术（TEP）期间髂静脉损伤及其安全处理技术的报道。我们报告一例75岁男性患者，既往有腹部手术史，计划行TEP修补腹股沟疝。手术过程中，髂静脉受损。如果在这种情况下进行剖腹手术，患者潜在的危及生命的状况可能会进一步恶化。相反，为避免潜在的二氧化碳相关栓塞，逐渐降低腹膜前压力，并增加呼气末正压（PEEP），以实现过度出血与潜在二氧化碳栓塞发展之间的平衡。在内镜下缝合受损静脉，并应用止血补片。然后我们继续进行计划好的手术。术后第14天前预防性给予低分子量肝素以防止缝合静脉血栓形成。我们得出结论，在TEP期间发生大静脉损伤的情况下，无论既往是否有腹部手术，都可通过调整腹膜前压力和PEEP来处理该并发症。
