Modified Lichtenstein mesh repair, for a patient of Coronary Artery Disease, Heart Failure and with Implanted Cardioverter- Defibrillator

Dr. Sreedhara V Setty*

HOD – Surgical Gastroenterology & General Surgery, Kauvery Hospital, Electronic City, Bengaluru

Case Presentation

A 62 years old male, a resident of Udupi, was refused surgery for a symptomatic right inguinal-scrotal hernia at a hospital of international repute in Mangalore as high risk.

He had undergone an implantable cardioverter-defibrillator (ICD) 2 years ago for heart failure secondary to MI. Only the anterior wall of the heart was viable. He was unable to do daily chores because of severe pain in his groin experienced.

Their concern was understandable because the patient continued to have frequent breathlessness requiring IV Lasix from his son, who was a lab technician. The perioperative risk was very high.

A colleague of ours referred this patient to us. After a thorough evaluation, and after discussion with cardiologists, intensivists & anaesthetists, the patient was offered surgery.

Pre-OP

The patient stopped ecospirin 3 days prior to surgery. A day before surgery he was admitted to ICU, and ICD settings were changed to withstand the stress of the surgical procedure. He was started on Dobutamine to help with heart failure.

Surgery

On day surgery, Anaesthetists gave the Genito-femoral nerve, ilio-inguinal & ilio-hypogastric blocks. Under their continuous care, Modified Lichtenstein mesh repair was performed. We didn’t use monopolar cautery. Instead, we used only bipolar energy.

Post-procedure

The patient was monitored in ICU for 6 hours and restarted all previous cardiac medications.

He was started on oral feeds immediately post-op and discharged on post-op day 1.

Dr. Sreedhara V Setty

HOD – Surgical Gastroenterology & General Surgery

Modified Lichtenstein mesh repair, for a patient of Coronary Artery Disease, Heart Failure and with Implanted Cardioverter- Defibrillator

Modified Lichtenstein mesh repair, for a patient of Coronary Artery Disease, Heart Failure and with Implanted Cardioverter- Defibrillator

Dr. Sreedhara V Setty

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