Perioperative management - Laparoscopic spigelian herniorraphy

Absolute indication:

• Incarceration, manifest or suspected

Relative indication:

• Complaints
• Pain
• Impaired intestinal passage
• Palpable hernia mass

• 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)

• 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

• 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

• 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