Ventral hernia repair
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Revision as of 11:48, 14 March 2022 by Olivia Sutton (talk | contribs)
Ventral hernia repair
| Anesthesia type |
GA |
|---|---|
| Airway |
ETT |
| Lines and access |
20G acceptable |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
Avoid coughing with extubation, consider deep extubation |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Ventral hernias are a common complication of intra-abdominal 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
- 20G PIV 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 challenge the incision.
- Some surgeons place abdominal binder before vs. after emergence, which are tight and can cause some restriction with breathing.
- Deep extubation is popular
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