Perioperative management - Laparoscopic spigelian herniorraphy - general and visceral surgery
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Indications
Absolute indication:
- Incarceration, manifest or suspected
Relative indication:
- Complaints
- Pain
- Impaired intestinal passage
- Palpable hernia mass
Contraindications
- No contraindication in incarcerated hernias
- In case of relative indication for surgery, factor in the general state of health, any comorbidity and burden of suffering (risk-benefit analysis)
Preoperative diagnostic work-up
- Thorough history
- Clinical examination with patient supine and standing (palpable hernia mass or orifice, tenderness etc.)
- Ultrasonography
- In equivocal findings CT scan and/or NMR
Special preparation
- Lab panels in healthy patients:
- Red blood count, electrolytes, creatinine, coagulation status
- Lab panels in case of comorbidities:
- For instance, transaminases, complete kidney panel etc.
- ECG
- Chest films in patients > 55 years, in younger patients only in case of relevant comorbidity
Informed consent
- Recurrent hernia
- Injury to abdominal organs
- (Secondary) bleeding
- Skin nerve injury
- Hypersensitivity reaction to foreign body material, with possible need for explantation later on.
- Wound infection
- DVT of lower extremities, embolism.
- Thrombosis prophylaxis, HIT syndrome
- Pneumonia
- Exuberant scarring
- Intra-abdominal adhesions
- Unexpected necessity to widen the procedure.
- In minimally invasive procedures, possible need to convert to open surgery.
- Trocar hernia
- Postoperative shoulder pain following laparoscopy
- Skin emphysema
Anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative Behandlung
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