Difference between revisions of "Inguinal hernia repair"
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!Laparoscopic | !Laparoscopic | ||
! | !Local/MAC | ||
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|PACU | |PACU | ||
|1-2h in PACU > home | |1-2h in PACU > home | ||
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|Pain score | |Pain score | ||
Revision as of 15:16, 15 April 2021
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
Peripheral IV |
| Monitors |
Standard ASA / 5-Lead EKG |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
RSI if urgent/emergent |
| Postoperative |
PONV, urinary retention |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Inguinal hernia repair is performed to fix a defect in the abdominal wall that allows abdominal contents to protrude into the inguinal canal, and it is one of the most commonly performed surgeries worldwide. This procedure is most commonly performed laparoscopically, especially in patients with recurrent or bilateral hernias, but can be performed open as well.[1]
Preoperative management
Patient evaluation
Adult patients presenting for laparoscopic hernia repair are usually healthy. However, this surgery can be emergent in cases of hernia incarceration or strangulation, usually requiring an open procedure.
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | Strangulation of hernia may result in hypotension, tachycardia |
| Respiratory | |
| Gastrointestinal | In cases of strangulation, patients may be dehydrated from fever and emesis |
| Hematologic | In cases of strangulation, patient may have leukocytosis/leukopenia |
| Renal | |
| Endocrine | |
| Labs | Hb/Hct for healthy patients, otherwise as indicated from H&P |
Operating room setup
- Standard GETA setup
Patient preparation and premedication
- Midazolam
- Tylenol 1g
Intraoperative management
Monitoring and access
- Standard ASA monitors
- 5-lead EKG
- Urinary catheter
- OG tube depending on surgeon preference
- 1-2 peripheral IVs
Induction and airway management
- Pre-oxygenate with 100% FiO2
- Standard induction and intubation
- Consider RSI in emergent cases in which patient has not been appropriately NPO
Positioning
- Supine, arms tucked
Maintenance and surgical considerations
- Standard maintenance
- Consider avoiding nitrous oxide given potential for bowel dissension and increased risk of PONV
- Place OG/NG before surgical incision to decompress the stomach
- Maintain normovolemia and normothermia
Emergence
- Avoid nitrous until after abdomen is de-insufflated
- PONV prophylaxis
Postoperative management
Disposition
- PACU/holding area for 1-2h followed by discharge home
Pain management
- Oral analgesics
- Non-opioid analgesics
- Ketoralac (Toradol)
- Acetaminophen (Tylenol)
- IV narcotics for breakthrough pain
Potential complications
- PONV
- Urinary retention (consider straight catheterization of bladder prior to emergence)
- Hemorrhage from trocar insertion
- Subcutaneous emphysema from pneumoperitoneum
Procedure variants
| Open | Laparoscopic | Local/MAC | |
|---|---|---|---|
| Unique considerations | Preferred for recurrent or bilateral hernias | Surgeon performed blocks/local infiltration
Generally surgeon-specific and elective cases with appropriate patients. | |
| Position | Supine | Supine, arms tucked | Supine, arms out |
| Surgical time | 1-2h | 1-2h | |
| EBL | <50mL | <50mL | |
| Postoperative disposition | PACU | 1-2h in PACU > home | PACU |
| Pain score | 3-4 | ||
| Potential complications | Recurrence of hernia
Orchalgia, neuralgia Bowel obstruction Bladder injury (rare) |
References
- ↑ Jaffe, Richard A; Schmiesing, Clifford A; Golianu, Brenda (2014). Anesthesiologist's manual of surgical procedures. ISBN 978-1-4963-0594-7. OCLC 888551588.