INGUINAL HERNIA REPAIR​

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An inguinal hernia occurs when part of the intestine or fat pushes through a weak spot in the lower abdominal wall (the inguinal canal). Inguinal hernias are the most common type of hernia and are more common in men. They can be painful, especially when coughing, bending over, or lifting a heavy object.

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The repair of an inguinal hernia, also known as herniorrhaphy or hernioplasty, is a common surgical procedure. There are two primary types of surgery used to repair inguinal hernias: open surgery and laparoscopic surgery.

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Open Inguinal Hernia Repair (Herniorrhaphy):

1. Anesthesia: The patient is given general, spinal, or local anesthesia.

2. Incision: The surgeon makes an incision in the groin area, where the hernia is located.

3. Hernia Repair: The protruding tissue is pushed back into the abdomen, and the weakened area (the hernia sac) is sewn shut.

4. Reinforcement: Often, the weakened area is reinforced with a synthetic mesh or screen to provide additional support. This is called hernioplasty.

5. Closure: The incision is then closed with sutures, staples, or surgical glue.

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Laparoscopic Inguinal Hernia Repair:

1. Anesthesia: This procedure is typically done under general anesthesia.

2. Incisions: The surgeon makes several small incisions in the lower abdomen and inflates the abdomen with a harmless gas (carbon dioxide), which helps the surgeon see the abdominal organs more clearly.

3. Laparoscope Insertion: A thin tube with a tiny camera (laparoscope) is inserted into one incision.

4. Hernia Repair: Instruments are inserted in other incisions to repair the hernia. As with open hernia repair, a mesh may be used to reinforce the area.

5. Closure: The incisions are closed with sutures, staples, or surgical glue.

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                                                    Anesthetic Implications for Inguinal Hernia Repair

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Anesthesia type: General, local anesthesia, neuraxial

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Airway: ETT

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Preoperative:

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• A strangulated bowel in the hernia will require an emergency laparotomy and a bowel resection 

• A spinal block to the T6 level may be done

• The patient’s peritoneum is insufflated

• Paralytics are used

• Pneumoperitoneum effects: decreased in functional residual capacity (FRC), increased systemic vascular resistance (SVR), decreased venous return, decreased renal blood flow, increased risk of regurgitation and aspiration of gastric content

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Intraoperative:

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• Traction on the viscera can cause vagal stimulation and bradycardia

• Duration: 1-2 hours

• Position; Supine, one arm tucked to the side or arms tucked

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Postoperative:

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• Pain management

• PONV prophylaxis

• Avoid coughing and straining on emergence

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Complications:

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• Urinary retention

• Infection

• Hernia recurrence

• Nerve damage

• Hemorrhage

• Organ damage

• Subcutaneous emphysema from pneumoperitoneum

• Bowel obstruction

• Bladder injury

• Postoperative ileus seroma

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Sources:

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Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.

 

Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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