Difference between revisions of "Ventral hernia repair"

Ventral hernia repair
Anesthesia type	General
Airway	ETT
Lines and access	PIV
Monitors	Standard
	Primary anesthetic considerations
Preoperative
Intraoperative	Avoid coughing with extubation Consider deep extubation
Postoperative
	Article quality
Editor rating	In development
User likes	0

VisualWikitext

Latest revision as of 23:07, 4 April 2022

Ventral hernia repair is a procedure to correct ventral hernias, which are a common complication of intraabdominal surgery. Even after surgical repair, incisional hernias may return. Some ventral hernias can be congenital.

Preoperative management

Patient evaluation


System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

None

Operating room setup

Standard

Patient preparation and premedication

Standard

Regional and neuraxial techniques

TAP block can be considered for large/open procedures

Intraoperative management

Monitoring and access

Standard monitors
One peripheral IV is usually sufficient

Induction and airway management

Positioning

Supine, arms usually out for open procedures

Maintenance and surgical considerations

Standard laparoscopic concerns (peritoneal stretch response with insufflation, OG tube to suction out stomach prior to insufflation, etc)
Open procedures are usually quicker and easier for surgeons

Emergence

Avoid coughing with emergence, as increased intraabdominal pressure can stress the incision.
- Consider deep extubation
Some surgeons place abdominal binder before vs. after emergence, which are tight and can cause some restriction with breathing.

Postoperative management

Disposition

Pain management

Potential complications

Infection involving the prosthetic biomaterial (mesh)
Postoperative ileus seromas
DVT
Dehiscence with profound coughing during emergence

Procedure variants


	Laparoscopic	Open
Unique considerations
Position	Supine	Supine, arms usually out
Surgical time	Approximately 30 minutes longer than open	1-2 hours
EBL	Minimal
Postoperative disposition	PACU	PACU
Pain management	Not usually significantly painful	Consider TAP block if large incision/extensive
Potential complications

References

Top contributors: Olivia Sutton and Chris Rishel

@@ Line 1: / Line 1: @@
+{{Infobox surgical procedure
+| anesthesia_type = General
+| airway = ETT
+| lines_access = PIV
+| monitors = Standard
+| considerations_preoperative =
+| considerations_intraoperative = Avoid coughing with extubation
+Consider deep extubation
+| considerations_postoperative =
+}}
+'''Ventral hernia repair''' is a procedure to correct ventral hernias, which are a common complication of intraabdominal surgery. Even after surgical repair, incisional hernias may return. Some ventral hernias can be congenital.
+== Preoperative management ==
+=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
+{| class="wikitable"
+|+
+!System
+!Considerations
+|-
+|Airway
+|
+|-
+|Neurologic
+|
+|-
+|Cardiovascular
+|
+|-
+|Pulmonary
+|
+|-
+|Gastrointestinal
+|
+|-
+|Hematologic
+|
+|-
+|Renal
+|
+|-
+|Endocrine
+|
+|-
+|Other
+|
+|}
+=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
+* None
+=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
+* Standard
+=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
+* Standard
+=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
+* TAP block can be considered for large/open procedures
+== Intraoperative management ==
+=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
+* Standard monitors
+* One peripheral IV is usually sufficient
+=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
+=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
+* Supine, arms usually out for open procedures
+=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
+* Standard laparoscopic concerns (peritoneal stretch response with insufflation, OG tube to suction out stomach prior to insufflation, etc)
+* Open procedures are usually quicker and easier for surgeons
+=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
+* Avoid coughing with emergence, as increased intraabdominal pressure can stress the incision.
+**Consider deep extubation
+* Some surgeons place abdominal binder before vs. after emergence, which are tight and can cause some restriction with breathing.
+== Postoperative management ==
+=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
+=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
+=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
+* Infection involving the prosthetic biomaterial (mesh)
+* Postoperative ileus seromas
+* DVT
+* Dehiscence with profound coughing during emergence
+== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
+{| class="wikitable wikitable-horizontal-scroll"
+|+
+!
+!Laparoscopic
+!Open
+|-
+|Unique considerations
+|
+|
+|-
+|Position
+|Supine
+|Supine, arms usually out
+|-
+|Surgical time
+|Approximately 30 minutes longer than open
+|1-2 hours
+|-
+|EBL
+|Minimal
+|
+|-
+|Postoperative disposition
+|PACU
+|PACU
+|-
+|Pain management
+|Not usually significantly painful
+|Consider TAP block if large incision/extensive
+|-
+|Potential complications
+|
+|
+|}
+== References ==
+[[Category:Surgical procedures]]
+[[Category:General surgery]]
+[[Category:Intestinal surgery]]