UMBILICAL HERNIA REPAIR
Umbilical hernia repair is a surgical procedure used to fix umbilical hernias. An umbilical hernia occurs when part of the intestine or fatty tissue bulges through the abdominal muscles near the navel (belly button). This condition is common in infants, but it can also occur in adults, often due to repeated strain on the abdominal area.
The surgery typically involves:
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Anesthesia: The procedure is usually performed under general anesthesia, meaning the patient is asleep and pain-free during the operation.
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Incision: A small incision is made near the umbilicus (navel).
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Repairing the Hernia: The protruding tissue is placed back into the abdominal cavity, and the opening in the abdominal wall is closed with stitches. Sometimes, a mesh material is used to strengthen the area.
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Closing the Incision: The incision is then closed with sutures, staples, or surgical glue.
The goals of umbilical hernia repair are to relieve symptoms and to prevent complications like incarceration (trapping of the hernia) or strangulation (cutting off the blood supply to the herniated tissue), which can be life-threatening.
The recovery time can vary depending on the patient's overall health, the size of the hernia, and the specific details of the surgery. Most people can return to normal activities within a few weeks, but complete healing might take longer.
Anesthetic Implications for Umbilical Hernia Repair
Anesthesia type: General
Airway: ETT
Preoperative:
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The procedure can be performed as open or laparoscopic approach
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The patient’s peritoneum is insufflated
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Paralytics are used
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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
Intraoperative:
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Position: supine position with at least one arm tucked
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Traction on the viscera can cause vagal stimulation and bradycardia
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Mesh is used to help close and supplement large umbilical hernias
Postoperative:
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PONV prophylaxis
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Pain management
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Avoid coughing and straining on emergence
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Abdominal binder is placed after surgery
Complications:
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Urinary retention
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Infection
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Hernia recurrence
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Nerve damage
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Hemorrhage
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Organ damage
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Subcutaneous emphysema from pneumoperitoneum
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Bowel obstruction
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Bladder injury
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Postoperative ileus seroma
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DVT
Sources:
Elisha, S. (2010). Case Studies in Nurse Anesthesia.
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).
Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.