Perioperative management - Lichtenstein Repair of Inguinal Hernia - general and visceral surgery
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Indications
Elective:
- Primary inguinal hernia in patients > 30 years, except for small lateral hernias
- Recurrent inguinal hernia
Emergency surgery:
- Incarcerated inguinal hernia
Contraindications
- Patients who are absolutely inoperable
- No other contraindications since the procedure can be performed under local anesthetics
Preoperative diagnostic work-up
- Manual examination with patient standing
- Digital rectal examination in men > 50 years
Special preparation
- Marking the side of the hernia examined with the patient standing
- 1/2 hour before skin incision a single-shot antibiotic regimen is recommended, e.g., with 2nd generation cephalosporin
Informed consent
- Recurrence
- Seroma
- Hematoma
- Secondary healing
- Infection
- Mesh infection
- Vascular and nerve injury
- (Secondary) bleeding
- Chronic groin pain such as ilioinguinal syndrome
- Injury to the spermatic duct
- Testicular atrophy
- Redo procedure
- Bowel resection
- Death
Anesthesia
- Laryngeal mask airway
- General anesthesia in specific contraindications for laryngeal mask airway
- Local anesthesia
- Spinal anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
- Basic instrument tray
- Lichtenstein mesh
Postoperative Management
Postoperative analgesia:
Nonsteroidal anti-inflammatory drugs usually suffice; if necessary, they can be enhanced by opioid analgesics.
Follow this link to PROSPECT (Procedures Specific Postoperative Pain Management).
This link will take you to the International Guideline Library.
Postoperative care:
After the operation a sand bag may be placed on the wound for a few hours; remove any Redon drain on postoperative day 1 or 2
Deep venous thrombosis prophylaxis:
Unless contraindicated, the moderate risk of thromboembolism (surgical operating time > 30 min) calls for prophylactic physical measures and low-molecular-weight heparin, possibly adapted to weight or dispositional risk, until full ambulation is reached.
Note: Renal function, HIT II (history, platelet check)
This link will take you to the International Guideline Library.
Ambulation:
Unrestricted; gradual return to physical activity; full physical activity, as tolerated, after one week; all activities permitted after four weeks the latest.
Physical therapy:
Respiratory therapy for prevention of pneumonia only in bedridden patients.
Diet:
Unrestricted
Bowel movement:
Laxatives may have to be started on postoperative day 2
Work disability:
1-2 weeks