VENTRAL HERNIA REPAIR

 

Ventral hernia repair is a surgical procedure used to correct ventral hernias. Ventral hernias are a type of abdominal wall hernia where tissue, usually intestine, protrudes through a weak spot in the abdominal muscles. These hernias can occur at any location on the abdominal wall but are most common along the midline.

​

The goals of ventral hernia repair are to return the herniated tissues to their proper place, strengthen the weakened area of the abdominal wall, and reduce the risk of hernia recurrence. This repair can be done using different surgical techniques, which are generally categorized into two main types: open repair and minimally invasive repair.

​

1. Open Repair: This traditional method involves making a large incision over the hernia site. The surgeon then pushes the protruding tissue back into place and repairs the weakened area. This is often reinforced with surgical mesh to provide additional support.

2. Minimally Invasive Repair: This approach, which includes laparoscopic and robotic surgeries, involves making several small incisions through which surgical instruments and a camera are inserted. The surgeon performs the repair guided by the video from the camera. This method typically results in less pain and a quicker recovery compared to open repair.

                                                                                                 

                                                    Anesthetic Implications for Ventral Hernia Repair

​

Anesthesia type: General, regional anesthesia

​

Airway: ETT

​​

Preoperative:

​​

• The procedure can be performed as open or laparoscopic approach

• The patient’s peritoneum is insufflated

• OG tube to suction out stomach prior to insufflation

• 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

• TAP block can be considered for large/open procedures

​​

Intraoperative:

​

• Position:  supine, arms out

• Traction on the viscera can cause vagal stimulation and bradycardia

• Mesh is used to help close and supplement large umbilical hernias

​

Postoperative:

​

• PONV prophylaxis

• Pain management

• Avoid coughing and straining on emergence

​​

Complications:

​

• Urinary retention

• Infection

• Hernia recurrence

• Nerve damage

• Hemorrhage

• Organ damage

• Subcutaneous emphysema from pneumoperitoneum

• Bowel obstruction

• Bladder injury

• Postoperative ileus seroma

• 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.

​

​

​

​

 

​​

​​