Perioperative management - Laparoscopic spigelian herniorraphy

  1. Indications

    Absolute indication:

    • Incarceration, manifest or suspected

    Relative indication:

    • Complaints
    • Pain
    • Impaired intestinal passage
    • Palpable hernia mass
  2. 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)
  3. 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
  4. 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
  5. 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

General anesthesia in pneumoperitoneum ... - Operations in general, visceral and transplant surgery

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