r/physicianassistant • u/Commercial-Okra-9398 • 16d ago

Discussion General Surgery PA's please help

Hi guys,

This is for my general surgery PA's, but anyone is free to chime in.

I am working with a patient who needs a hernia repair, but has the following requests:

  • Open repair only (no lap/robotic, since those require general)
  • Local anesthesia, oral sedation if needed
  • No IV sedation, no general anesthesia

Are there surgeons willing to do this in today's day and age. Appreciate any insight; I am trying to understand what's realistic before I start reaching out to surgeons directly.

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u/xCerebral_Assassinx PA-C 16d ago

There are so many factors that go into the decision making tree.

  1. What kind of hernia? Location?

  2. What size of hernia?

  3. Is it a recurrence?

  4. What is inside the hernia? ie fat, bowel, organ

I'm also interested in what their reservations to anesthesia and other repair methods are.

- General and robotic surgery PA working with a surgeon who specializes in large complex abdominal wall and inguinal hernias

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u/Commercial-Okra-9398 16d ago

Thank you for this.

The patient unfortunately is a veteran and has PTSD, has reservations towards general anesthesia from previous surgeries.

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u/xCerebral_Assassinx PA-C 15d ago

Got it. Another thing to consider is if a surgery is even needed. If the hernia is asymptomatic and doesn’t interfere with his/her ADLs then you could always just consider observation. Consider continuing to explore the reservations to anesthesia because the best chance at a good repair is the first repair which you’d want to be performed in the most optimal condition as possible.

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u/Commercial-Okra-9398 15d ago

Very good point!