Hernia Repair

Herniorrhaphy (Hernioplasty, Hernia repair) is a surgical procedure for correcting hernias. A hernia is a bulging of internal organs or tissues that protrude through an abnormal opening in the muscle wall. Hernias can occur in the abdomen, groin, or at the site of previous surgery.

An operation in which the hernia sac is removed without any repair of the inguinal canal is described as a 'herniotomy.

When herniotomy is combined with a reinforced repair of the posterior inguinal canal wall with autogenous (patient's tissue) or heterogeneous (like steel or prolene mesh) material, it is termed Hernioplasty.

Hernia repair is predominantly male: female 85:15

Associated conditions are chronic cough, urinary retention, chronic constipation, pregnancy, vomiting, and increased BMI.

Risk of damage to nerves, spermatic cord, and blood supply to testes.

Complications

Wound abscess <3%

Wound hematoma < 2%

Pain score 4-5

Anesthetic Considerations

Supine position

Antibiotics preoperatively

Possible electrolyte imbalance if the hernia becomes incarcerated, obstructed, or strangulated

Spinal

Check coagulation status - need T4-T6 level

• 75% bupivacaine in 8.25% dextrose (10-15 mg)
• 5% tetracaine in 5% dextrose (12-16 mg)
  • Consider adding fentanyl 10-20 mcg

Epidural

Sitting or lateral decubitus for placement

Test dose: 3 mL of 1.5% lidocaine with 1:200,000 epinephrine to determine if the catheter is subarachnoid or intravascular

Titrate lidocaine 1-2% or 0.5% bupivacaine - usually 5-7 mL at a time, total usually 20 mL

Consider adding fentanyl 25-100 mcg

GETA

LMA or ETT depending on history (obstruction, incarceration, strangulation) and surgical need for relaxed abdominal wall

Prevent coughing/straining during emergence to prevent dehiscence

Vagal reflex due to bowel traction, leading to decreased HR and BP