Ventral Hernia Repair

Anesthesia Implications

Position: Supine, arms tucked
Time: 1-2 hours (average)
Blood Loss: Low (10-50 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Yes

Surgical Approaches – Some surgeons may elect to use a robot for this surgery (refer to “Robotic Anything”). Ventral hernias can also be repaired with an open procedure, which cuts down on the time of anesthesia considerably (when compared to robotic repair). In this case, have a quick wakeup plan ready. Deep MACs are not recommended, but can be done in non-robotic cases.

Extubation – Deep extubation is recommended (if not contraindicated) to avoid coughing. Avoiding coughing will be important to protect the incision and avoid dehiscence.

Abdominal binder – this may be placed post-procedure. The abdominal binder can add substantial pain and pressure to the abdomen, so have post-op pain medication readily available.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

Ventral hernias are non-inguinal, nonhiatal defects in the fascia of the abdominal wall.

A hernia, in general, is any protrusion/bulge out of the tissues that normally contain it. The abdominal wall contains multiple tissues including muscle and connective tissue which spans from the xiphoid process to the pubic symphasis and iliac crest.

Abdominal hernias are primarily caused by a weakening of the tissues contain the abdominal viscera.

Abdominal hernias may be classified as ventral, groin (inguinal and femoral subclassifications), pelvic, and flank. Approximately 5 million American’s have abdominal hernias. The majority are groin hernias.

Further classification may be used in conjunction with the etiology: congenital (such as gastroschisis or omphalocele) and acquired (weakening or disruption of the wall tissues).

Hernias are far more common in men (10x) than women.