Difference between revisions of "Inguinal hernia repair"

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| considerations_intraoperative = RSI if urgent/emergent
 
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Surgical repair of inguinal hernias 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.  
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Surgical repair of inguinal hernias 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.<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>
  
 
== Preoperative management ==
 
== Preoperative management ==
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|Cardiovascular
 
|Cardiovascular
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|Strangulation of hernia may result in hypotension, tachycardia
 
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|Respiratory
 
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|Gastrointestinal
 
|Gastrointestinal
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|In cases of strangulation, patients may be dehydrated from fever and emesis
* In cases of strangulation, patients may be dehydrated from fever and emesis
 
 
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|Hematologic
 
|Hematologic
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|In cases of strangulation, patient may have leukocytosis/leukopenia
 
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|Renal
 
|Renal
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|Labs
 
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|Hb/Hct for healthy patients, otherwise as indicated from H&P
* Hb/Hct for healthy patients, otherwise as indicated from H&P
 
 
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=== Operating room setup ===
 
=== Operating room setup ===
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* Standard GETA setup
  
 
=== Patient preparation and premedication ===
 
=== Patient preparation and premedication ===
  
=== 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. --> ===
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* Midazolam
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* Tylenol 1g
  
 
== Intraoperative management ==
 
== 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. --> ===
 
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
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* Standard ASA monitors
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* 5-lead EKG
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* Urinary catheter
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* OG tube depending on surgeon preference
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* 1-2 peripheral IVs
  
 
=== 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. --> ===
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=== 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. --> ===
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* Avoid nitrous until after abdomen is de-insufflated
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* PONV prophylaxis
  
 
== Postoperative management ==
 
== Postoperative management ==
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|Postoperative disposition
 
|Postoperative disposition
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|PACU
 
|1-2h in PACU > home
 
|1-2h in PACU > home
 
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== References ==
 
== References ==
 
 
[[Category:Surgical procedures]]
 
[[Category:Surgical procedures]]
 
[[Category:General surgery]]
 
[[Category:General surgery]]
 
[[Category:Intestinal surgery]]
 
[[Category:Intestinal surgery]]

Revision as of 15:47, 30 March 2021

Inguinal hernia repair
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


Surgical repair of inguinal hernias 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
Unique considerations Preferred for recurrent or bilateral hernias
Position Supine Supine, arms tucked
Surgical time 1-2h
EBL <50mL
Postoperative disposition PACU 1-2h in PACU > home
Pain score 3-4
Potential complications Recurrence of hernia

Orchalgia, neuralgia

Bowel obstruction

Bladder injury (rare)

References

  1. Jaffe, Richard A; Schmiesing, Clifford A; Golianu, Brenda (2014). Anesthesiologist's manual of surgical procedures. ISBN 978-1-4963-0594-7. OCLC 888551588.