Difference between revisions of "Inguinal hernia repair"
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{{Infobox surgical case reference | {{Infobox surgical case reference | ||
| anesthesia_type = General | | anesthesia_type = General or spinal or local | ||
| airway = ETT | | airway = ETT/LMA if GA | ||
| lines_access = Peripheral IV | | lines_access = Peripheral IV | ||
| monitors = Standard | | monitors = Standard | ||
5-Lead ECG | |||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = RSI if | | considerations_intraoperative = RSI if nonelective | ||
| considerations_postoperative = PONV | | considerations_postoperative = PONV | ||
Urinary retention | |||
}} | }} | ||
'''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 commonly performed laparoscopically, especially in patients with recurrent or bilateral hernias, but can be performed open as well.<ref>{{Cite book|last=Jaffe|first=Richard A|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805|title=Anesthesiologist's manual of surgical procedures|last2=Schmiesing|first2=Clifford A|last3=Golianu|first3=Brenda|date=2014|isbn=978-1-4963-0594-7|language=English|oclc=888551588}}</ref> | '''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 commonly performed laparoscopically, especially in patients with recurrent or bilateral hernias, but can be performed open as well.<ref>{{Cite book|last=Jaffe|first=Richard A|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805|title=Anesthesiologist's manual of surgical procedures|last2=Schmiesing|first2=Clifford A|last3=Golianu|first3=Brenda|date=2014|isbn=978-1-4963-0594-7|language=English|oclc=888551588}}</ref> | ||
Latest revision as of 23:05, 4 April 2022
Inguinal hernia repair
| Anesthesia type |
General or spinal or local |
|---|---|
| Airway |
ETT/LMA if GA |
| Lines and access |
Peripheral IV |
| Monitors |
Standard 5-Lead ECG |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
RSI if nonelective |
| 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 commonly performed laparoscopically, especially in patients with recurrent or bilateral hernias, but can be performed open as well.[1]
The anesthetic technique ranges from local to spinal to general anesthesia. For a patient with no existing comorbidities, the decision can be based on the complexity of the anatomy, expected duration, surgeon preference, and/or patient preference. Studies have found no difference between spinal vs GA (with LMA) in early or late outcomes[2].
Preoperative management
Patient evaluation
Adult patients presenting for inguinal hernia repair are usually healthy and this procedure is typically performed in the outpatient setting. However, this surgery can be emergent in cases of hernia incarceration or strangulation, usually requiring an open procedure.
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | If strangulated, hypotension and tachycardia possible |
| Respiratory | |
| Gastrointestinal | If strangulated, dehydration from fever and emesis possible |
| Hematologic | If strangulated, leukocytosis/leukopenia possible |
| Renal | |
| Endocrine | |
| Labs | Hb/Hct for healthy patients, otherwise as indicated from H&P |
Operating room setup
Patient preparation and premedication
- Midazolam
- Tylenol 1g
Intraoperative management
Monitoring and access
- Standard ASA monitors
- 5-lead EKG
- 1 peripheral IV
- Consider:
- Urinary catheter
- OG tube
Induction and airway management
- If general, ETT vs. LMA
- ETT with RSI if urgency does not allow appropriate NPO
Positioning
- Supine, arms tucked
Maintenance and surgical considerations
- If laparoscopic, place OG/NG before surgical incision to decompress the stomach if indicated
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)
- If laparoscopic, hemorrhage or organ damage from trocar insertion
- Subcutaneous emphysema from pneumoperitoneum
Procedure variants
| Open | Laparoscopic | Local/MAC | |
|---|---|---|---|
| Unique considerations | Preferred for recurrent or bilateral hernias | Appropriate in some elective cases, surgeon-dependent | |
| 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 |
|
References
- ↑ Jaffe, Richard A; Schmiesing, Clifford A; Golianu, Brenda (2014). Anesthesiologist's manual of surgical procedures. ISBN 978-1-4963-0594-7. OCLC 888551588.
- ↑ Burney, Richard E. (2004-02-01). "Comparison of Spinal vs General Anesthesia via Laryngeal Mask Airway in Inguinal Hernia Repair". Archives of Surgery. 139 (2): 183. doi:10.1001/archsurg.139.2.183. ISSN 0004-0010.