Comparison of extraperitoneal and intraperitoneal laparoscopic procedures for intracranial pressure increase: a prospective clinical study

I. Hasirci, E. Ulutas, A. Polat, A. Harb, Y. Tire, A. Kartal

General Surgery, Konya City Hospital, University of Health Science, Konya, Turkey. dryasintire@hotmail.com

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• Surgery

OBJECTIVE: According to the literature, higher levels of both intracranial pressure (ICP) and intraabdominal pressure (IAP) are related in a way that suggests a causal relationship. An increase in ICP can cause major neurological problems both during and after laparoscopic surgery. In this study, we aimed to examine the increase in ICP between totally extraperitoneal (TEP) inguinal hernia repair and laparoscopic cholecystectomy.

PATIENTS AND METHODS: We investigated 52 individuals who underwent laparoscopic surgery for the treatment of inguinal hernia (n = 26) or had a laparoscopic cholecystectomy (n = 26). The optic nerve sheath diameter (ONSD) was assessed before the procedure (T0), 10 minutes after carbon dioxide insufflation (T1), and immediately before extubation (T2).

RESULTS: There were significant differences in the ONSD values between the two groups as a function of time (p = 0.001). In terms of ONSD, the laparoscopic cholecystectomy value (LV) group showed a greater shift from T0 to T1 and T2 than the inguinal hernia value (HV) group. At T1, the ONSD values of both groups were considerably higher than those of T0 and T2. The impact of the extraperitoneal and transperitoneal laparoscopic methods on ICP was investigated. The ONSD value reached its maximum at T1 in both groups. At all measurement periods, the ONSD values of the LV group were noticeably higher than those of the HV group.

CONCLUSIONS: The diagnostic accuracy of ONSD ultrasonography is an important approach for determining the ICP level. During the decision-making process of TEP inguinal hernia repair, this study can guide medical professionals in the evaluation of elevated ICP.

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