The safety and efficacy of low pneumoperitoneum pressure compared with standard pneumoperitoneum pressure in laparoscopic inguinal hernia repair: a prospective, double-blind, randomized controlled study protocol design.

Abstract

<h4>Background</h4>Inguinal hernia is a common disease, and laparoscopic tension-free inguinal hernia repair has become the standard procedure for treating inguinal hernia. During surgery, carbon dioxide gas is injected into the patient's abdominal cavity to maintain a specific pneumoperitoneum pressure. Under standard pneumoperitoneum pressure (SPP), we occasionally observe that some patients are prone to subcutaneous emphysema and hypercarbia, especially elderly patients with inguinal hernias, where the occurrence is relatively high. The aim of this study was to analyse whether using lower pneumoperitoneum pressure (LPP) in laparoscopic hernia repair is safer while maintaining surgical success.<h4>Methods</h4>This was a prospective, double-blind, randomized controlled study in which patients were randomly assigned to either the LPP group or the SPP group. The primary outcome measures were the results of patients' arterial blood gas analysis, including partial pressure of carbon dioxide (PaCO2), arterial oxygen partial pressure (PaO2), pH value, arterial oxygen saturation (SaO2), whole blood base excess (ABE), and standard base excess (SBE). The secondary outcome measures included heart rate, blood pressure, cardiac output (CO), stroke volume (SV), end-tidal carbon dioxide pressure (PetCO2), airway pressure (Paw), intraoperative complications, surgical duration, anesthesia recovery time, Length of hospital stay, postoperative pain, and quality of life. The aim of this study was to analyse the differences in these indicators between the two groups of patients.<h4>Discussion</h4>Compared with laparoscopic inguinal hernia repair performed under SPP, the use of LPP in laparoscopic inguinal hernia repair is advantageous for improving patients' blood gas analysis and systemic circulatory indicators. This study demonstrated that LPP for inguinal hernia repair is safe and effective, providing evidence-based support for the selection of pneumoperitoneum pressure values.<h4>Trial registration</h4>Chinese Clinical Trial Registry, ChiCTR2400091218, Registered on October 23, 2024.