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
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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