00756 Anesthesia for hernia repairs in upper abdomen; transabdominal repair of diaphragmatic hernia

Name of the Procedure:

Anesthesia for hernia repairs in upper abdomen; transabdominal repair of diaphragmatic hernia
Common Name(s): Diaphragmatic hernia repair, Transabdominal hernia surgery

Summary

This procedure involves providing anesthesia for the surgical repair of a hernia located in the upper abdomen, particularly a diaphragmatic hernia. This type of hernia occurs when abdominal organs push through a weakness in the diaphragm into the chest cavity.

Purpose

The procedure aims to repair and close the opening in the diaphragm, thereby preventing abdominal organs from entering the chest cavity. The expected outcome is to relieve symptoms, prevent complications, and restore normal anatomy.

Indications

• Presence of a diaphragmatic hernia diagnosed through imaging.
• Symptoms such as difficulty breathing, chest pain, or gastrointestinal issues.
• Risk factors like trauma, congenital conditions, or previous surgical complications.

Preparation

• Patients are typically required to fast for 8-12 hours before surgery.
• Preoperative tests may include blood work, chest X-ray, ECG, and a CT scan.
• Medication adjustments, such as stopping blood thinners or certain other drugs.

Procedure Description

1. Anesthesia: Administered by an anesthesiologist involves general anesthesia to keep the patient unconscious and pain-free during the surgery.
2. Incision: A transabdominal incision is made to access the hernia.
3. Repair: The surgeon pushes the protruding organs back into the abdomen and repairs the diaphragmatic opening, often using surgical mesh for reinforcement.
4. Closure: The incision is closed with sutures or staples.

The procedure utilizes surgical tools like scalpels, retractors, and laparoscopic instruments, if a minimally invasive approach is chosen.

Duration

The surgery typically lasts between 2 to 4 hours.

Setting

Performed in a hospital operating room, given the need for full surgical facilities and equipment.

Personnel

• Surgeons specializing in gastrointestinal or thoracic surgery
• Anesthesiologist for administering anesthesia
• Surgical nurses and operating room technicians

Risks and Complications

• Common: Infection, bleeding, anesthesia reactions.
• Rare: Organ injury, prolonged recovery, recurrence of hernia, and complications from mesh.

Benefits

• Relief from symptoms such as pain and breathing difficulties.
• Prevention of further complications like organ strangulation.
• Most benefits realized within weeks, with full recovery expected in a few months.

Recovery

• Post-procedure involves monitoring in a recovery room.
• Pain management typically includes prescribed pain medications.
• Instructions may include restricted physical activity for several weeks and follow-up appointments for suture or staple removal and healing assessment.

Alternatives

• Non-surgical options include managing symptoms with medications and lifestyle adjustments.
• Watchful waiting in asymptomatic or minimally symptomatic cases.
• Pros and cons should be discussed with a healthcare provider to determine suitability based on severity and patient health status.

Patient Experience

Patients may experience discomfort and soreness post-operation, usually managed with pain medications. Initial recovery includes rest and limited movement, gradually returning to normal activities as advised by the surgeon.