Difference between revisions of "Ventral hernia repair"
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{{Infobox surgical procedure | |||
| anesthesia_type = GA | |||
| airway = ETT | |||
| lines_access = 20G acceptable | |||
| monitors = Standard | |||
| considerations_preoperative = | |||
| considerations_intraoperative = Avoid coughing with extubation, consider deep extubation | |||
| considerations_postoperative = | |||
}} | |||
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<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> === | |||
{| class="wikitable" | |||
|+ | |||
!System | |||
!Considerations | |||
|- | |||
|Airway | |||
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|- | |||
|Neurologic | |||
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|Cardiovascular | |||
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|Pulmonary | |||
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|- | |||
|Gastrointestinal | |||
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|- | |||
|Hematologic | |||
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|- | |||
|Renal | |||
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|- | |||
|Endocrine | |||
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|- | |||
|Other | |||
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|} | |||
=== 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 | |||
* 20G PIV 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 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<!-- 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]] | |||
Revision as of 12:48, 14 March 2022
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