Difference between revisions of "Ventral hernia repair"
From WikiAnesthesia
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = General | ||
| airway = ETT | | airway = ETT | ||
| lines_access = | | lines_access = PIV | ||
| monitors = Standard | | monitors = Standard | ||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = Avoid coughing with extubation | | considerations_intraoperative = Avoid coughing with extubation | ||
Consider deep extubation | |||
| considerations_postoperative = | | considerations_postoperative = | ||
}} | }} | ||
Ventral hernias are a common complication of | '''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 == | == Preoperative management == | ||
| Line 68: | Line 69: | ||
* Standard monitors | * 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. --> === | === 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. --> === | ||
| Line 83: | Line 84: | ||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === 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 | * 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. | * Some surgeons place abdominal binder before vs. after emergence, which are tight and can cause some restriction with breathing. | ||
== Postoperative management == | == Postoperative management == | ||
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[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
[[Category:General surgery]] | |||
[[Category:Intestinal surgery]] | |||
Latest revision as of 23:07, 4 April 2022
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 | |
| User likes | 0 |
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