Knowledge of pathophysiological basis of laparoscopic procedures, that is, the influence of CO2 pneumoperitoneum (PNP) on the body in particular, can prevent the complications during laparoscopy to occur. Standard intra-abdominal pressure (IAP), which is used during laparoscopic surgery, is 12-15 mm / Hg. The direct effect of CO2 pneumoperitoneum is a result of mechanical action of the gas and increasement of intra-abdominal pressure (IAP). The indirect effect of CO2 pneumoperitoneum is caused by the absorption of gas inserted into the abdomen. Analysis of published articles that assess the effects of CO2 pneumoperitoneum on the body and abdominal organs contributes to a better usage of the laparoscopic method. Different techniques in laparoscopy, created as an alternative to standard CO2-pneumoperitoneum, have the task to reduce the risks for patients with comorbidity and simultaneously raise the abdominal wall and allow the surgeon to perform smooth operation, which is especially important for ASA III and ASA IV patients. Alternative techniques can be divided into three groups: laparoscopy using pneumoperitoneum with low intra-abdominal pressure (up to 8 mm / Hg), laparoscopy using retractors abdominal wall and limited pneumoperitoneum, and laparoscopy without the use of gas (gasless laparoscopy; raising the abdominal wall retractor only ). Low insufflation pressure in the abdomen (up to 8 mm / Hg) is beneficial for patients with laparoscopic procedures and its routine usage in elderly patients and patients with severe cardiorespiratory diseases, should be common practice. Gasless laparoscopy was created because of the need to prevent the negative effects of increased intra-abdominal pressure on the body during laparoscopy, primarily in patients with high comorbidity (ASA III and ASA IV). When compared to other techniques, numerous studies prefer laparoscopy with low insufflation pressure, but in practice this is not done routinely, yet each technique is applied selectively, according to the needs and condition of the patient, which is the most appropriate. To avoid the side effects of CO2 pneumoperitoneum, which is important in high-risk patients, it is more likely to operate on low IAP (6-8 mm / Hg) or use gasless laparoscopy. This is especially important for long – duration operations. DOI: 10.7251/SMDEN1501066H (Scr Med 2015:46:66-72)

ABSTRACT The aim: of this study was to compare two methods of polypropylene mesh fixation for inguinal hernia repair according to Lichtenstein using fibrin glue and suture fixation. Material and Methods: The study included 60 patients with unilateral inguinal hernia, divided into two groups of 30 patients – Suture fixation and fibrin glue fixation. All patients were analyzed according to: age, gender, body mass index (BMI), indication for surgery–the type, localization and size of the hernia, preoperative level of pain and the type of surgery. Overall postoperative complications and the patient’s ability to return to regular activities were followed for 3 months. Results and discussion: Statistically significant difference in the duration of surgery, pain intensity and complications (p<0.05) were verified between method A, the group of patients whose inguinal hernia was repaired using polypropylene mesh–fibrin glue and method B, where inguinal hernia was repaired with polypropylene mesh using suture fixation. Given the clinical research, this systematic review of existing results on the comparative effectiveness, will help in making important medical decisions about options for surgical treatment of inguinal hernia. Conclusions: The results of this study may impact decision making process for recommendations of methods of treatment by professional associations, making appropriate decisions on hospital procurement of materials, as well as coverage of health funds and insurance.