Inguinal hernia repair - Revision history

Sirromta: Note on intraoperative increase in vagal tone from CO2 insufflation

2026-03-30T12:10:28Z

Note on intraoperative increase in vagal tone from CO2 insufflation

← Older revision		Revision as of 05:10, 30 March 2026
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	*If laparoscopic, place OG/NG before surgical incision to decompress the stomach if indicated		*If laparoscopic, place OG/NG before surgical incision to decompress the stomach if indicated
			*If laparoscopic, increased vagal tone secondary to peritoneal distension from insufflation

	===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===		===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===

Chris.Rishel at 07:05, 5 April 2022

2022-04-05T07:05:09Z

← Older revision		Revision as of 00:05, 5 April 2022
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	{{Infobox surgical case reference		{{Infobox surgical case reference
	\| anesthesia_type = General ~~vs. Spinal vs. Local~~		\| anesthesia_type = General or spinal or local
	\| airway = ETT ~~vs.~~ LMA ~~for~~ GA		\| airway = ETT/LMA if GA
	\| lines_access = Peripheral IV		\| lines_access = Peripheral IV
	\| monitors = Standard ~~ASA /~~ 5-Lead ~~EKG~~		\| monitors = Standard
			5-Lead ECG
	\| considerations_preoperative =		\| considerations_preoperative =
	\| considerations_intraoperative = RSI if ~~urgent/emergent~~		\| considerations_intraoperative = RSI if nonelective
	\| considerations_postoperative = PONV~~, urinary~~ retention		\| considerations_postoperative = PONV
			Urinary retention
	}}		}}
	'''Inguinal hernia repair''' is performed to fix a defect in the abdominal wall that allows abdominal contents to protrude into the inguinal canal, and it is one of the most commonly performed surgeries worldwide. This procedure is commonly performed laparoscopically, especially in patients with recurrent or bilateral hernias, but can be performed open as well.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>		'''Inguinal hernia repair''' is performed to fix a defect in the abdominal wall that allows abdominal contents to protrude into the inguinal canal, and it is one of the most commonly performed surgeries worldwide. This procedure is commonly performed laparoscopically, especially in patients with recurrent or bilateral hernias, but can be performed open as well.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>

Chris.Rishel: Reorganized sections, reduced wording

2021-06-30T07:01:44Z

Reorganized sections, reduced wording

Show changes

Chris.Rishel: More CSS table issues

2021-06-30T05:18:55Z

More CSS table issues

← Older revision		Revision as of 22:18, 29 June 2021
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	== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==		== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==

	{\| class="wikitable"		{\| class="wikitable wikitable-horizontal-scroll"
	\|+		\|+
	!		!

Chris.Rishel at 05:07, 30 June 2021

2021-06-30T05:07:47Z

← Older revision		Revision as of 22:07, 29 June 2021
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	== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==		== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==

	{\| class="wikitable ~~wikitable-horizontal-scroll~~"		{\| class="wikitable"
	\|+		\|+
	!		!

Chris.Rishel: CSS for table

2021-06-30T05:04:47Z

CSS for table

← Older revision		Revision as of 22:04, 29 June 2021
Line 109:		Line 109:
	== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==		== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==

	{\| class="wikitable"		{\| class="wikitable wikitable-horizontal-scroll"
	\|+		\|+
	!		!

Chris.Rishel at 17:43, 12 May 2021

2021-05-12T17:43:29Z

← Older revision		Revision as of 10:43, 12 May 2021
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	\| considerations_postoperative = PONV, urinary retention		\| considerations_postoperative = PONV, urinary retention
	}}		}}

	'''Inguinal hernia repair''' is performed to fix a defect in the abdominal wall that allows abdominal contents to protrude into the inguinal canal, and it is one of the most commonly performed surgeries worldwide. This procedure is commonly performed laparoscopically, especially in patients with recurrent or bilateral hernias, but can be performed open as well.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref> The anesthetic technique ranges from local to spinal to general anesthesia.		'''Inguinal hernia repair''' is performed to fix a defect in the abdominal wall that allows abdominal contents to protrude into the inguinal canal, and it is one of the most commonly performed surgeries worldwide. This procedure is commonly performed laparoscopically, especially in patients with recurrent or bilateral hernias, but can be performed open as well.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref> The anesthetic technique ranges from local to spinal to general anesthesia.

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	=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===

			* If general, ETT vs. LMA
			** ETT with RSI if urgency does not allow appropriate NPO

	~~<u>For General Anesthesia</u>~~
	* Pre-oxygenate with 100% FiO2
	* Standard induction
	** Consider RSI in emergent cases in which patient has not been appropriately NPO
	* ETT vs. LMA
	**
	=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===

Barrett.Larson at 02:45, 7 May 2021

2021-05-07T02:45:30Z

← Older revision		Revision as of 19:45, 6 May 2021
Line 9:		Line 9:
	}}		}}

	'''Inguinal hernia repair''' is performed to fix a defect in the abdominal wall that allows abdominal contents to protrude into the inguinal canal, and it is one of the most commonly performed surgeries worldwide. This procedure is commonly performed laparoscopically, especially in patients with recurrent or bilateral hernias, but can be performed open as well.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>		'''Inguinal hernia repair''' is performed to fix a defect in the abdominal wall that allows abdominal contents to protrude into the inguinal canal, and it is one of the most commonly performed surgeries worldwide. This procedure is commonly performed laparoscopically, especially in patients with recurrent or bilateral hernias, but can be performed open as well.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref> The anesthetic technique ranges from local to spinal to general anesthesia.

	== Preoperative management ==		== Preoperative management ==

Barrett.Larson at 02:44, 7 May 2021

2021-05-07T02:44:29Z

← Older revision		Revision as of 19:44, 6 May 2021
Line 1:		Line 1:
	{{Infobox surgical case reference		{{Infobox surgical case reference
	\| anesthesia_type = General		\| anesthesia_type = General vs. Spinal vs. Local
	\| airway = ETT		\| airway = ETT vs. LMA for GA
	\| lines_access = Peripheral IV		\| lines_access = Peripheral IV
	\| monitors = Standard ASA / 5-Lead EKG		\| monitors = Standard ASA / 5-Lead EKG
Line 9:		Line 9:
	}}		}}

	'''Inguinal hernia repair''' is performed to fix a defect in the abdominal wall that allows abdominal contents to protrude into the inguinal canal, and it is one of the most commonly performed surgeries worldwide. This procedure is ~~most~~ commonly performed laparoscopically, especially in patients with recurrent or bilateral hernias, but can be performed open as well.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>		'''Inguinal hernia repair''' is performed to fix a defect in the abdominal wall that allows abdominal contents to protrude into the inguinal canal, and it is one of the most commonly performed surgeries worldwide. This procedure is commonly performed laparoscopically, especially in patients with recurrent or bilateral hernias, but can be performed open as well.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>

	== Preoperative management ==		== Preoperative management ==

	=== Patient evaluation ===		=== Patient evaluation ===
	Adult patients presenting for ~~laparoscopic~~ hernia repair are usually healthy. However, this surgery can be emergent in cases of hernia incarceration or strangulation, usually requiring an open procedure.		Adult patients presenting for inguinal hernia repair are usually healthy and this procedure is typically performed in the outpatient setting. However, this surgery can be emergent in cases of hernia incarceration or strangulation, usually requiring an open procedure.

	{\| class="wikitable"		{\| class="wikitable"
	\|+		\|+
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	=== Operating room setup ===		=== Operating room setup ===

	* ~~Standard GETA setup~~		* The choice of anesthetic technique ranges from local infiltration to spinal to general. For a patient with no existing comorbidities, the decision can be based on the complexity of the anatomy, expected duration, surgeon preference, and/or patient preference. Studies have found no difference between spinal vs GA (with LMA) in early or late outcomes<ref>{{Cite journal\|last=Burney\|first=Richard E.\|date=2004-02-01\|title=Comparison of Spinal vs General Anesthesia via Laryngeal Mask Airway in Inguinal Hernia Repair\|url=https://jamanetwork.com/journals/jamasurgery/fullarticle/396375\|journal=Archives of Surgery\|language=en\|volume=139\|issue=2\|pages=183\|doi=10.1001/archsurg.139.2.183\|issn=0004-0010}}</ref>.

	=== Patient preparation and premedication ===		=== Patient preparation and premedication ===
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	* Standard ASA monitors		* Standard ASA monitors
	* 5-lead EKG		* 5-lead EKG
	* Urinary catheter		* 1 peripheral IV
	* OG tube ~~depending on surgeon preference~~		* Consider:
	* 1-2 peripheral IVs		** Urinary catheter
			** OG tube

	=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===


			<u>For General Anesthesia</u>
	* Pre-oxygenate with 100% FiO2		* Pre-oxygenate with 100% FiO2
	* Standard induction ~~and intubation~~		* Standard induction
	** Consider RSI in emergent cases in which patient has not been appropriately NPO		** Consider RSI in emergent cases in which patient has not been appropriately NPO
			* ETT vs. LMA
			**
	=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===

Chetra.Yean at 23:16, 15 April 2021

2021-04-15T23:16:14Z

← Older revision		Revision as of 16:16, 15 April 2021
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	!Open		!Open
	!Laparoscopic		!Laparoscopic
	!~~Regional-~~Local/MAC		!Local/MAC
	\|-		\|-
	\|Unique considerations		\|Unique considerations
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	\|PACU		\|PACU
	\|1-2h in PACU > home		\|1-2h in PACU > home
	\|		\|PACU
	\|-		\|-
	\|Pain score		\|Pain score