Bullous emphysema, inguinal hernia

41-year-old man for consideration of Open Right inguinal Hernia repair



  • Symptomatic right inguinal hernia, contributing to chronic pain
  • Intermittent obstructive urinary symptoms
  • Severe bullous emphysema – currently being worked-up for double lung transplant
    • Ceased smoking 2 years, 25 pack year history
    • Previous heavy marijuana use – now ceased
    • Pulmonary rehabilitation ongoing, very motivated
    • No hospital admissions with LRTI, no history bullae rupture
    • Formal spirometry: FEV1=2.19 (58%), FVC=3.77 (82%), TLCO=39%
    • 6MWT = 518m – 81% of normal distance for age
  • Normal sleep study and Echo
  • DASI 6.2MET’s
  • Chronic pancreatitis, no alcohol use
  • Chronic pain and significant anxiety/depression issues.


Timing of surgery

  • Consensus that is appropriate to perform hernia surgery prior to transplant
  • Patient is experiencing discomfort from hernia and transplant surgery may be years away


  • Fully optimised from respiratory perspective, and had all relevant respiratory and cardiac investigations
  • Chronic pain is a concern, especially with a view to transplant surgery

Anaesthetic Techniques

  • Patient is very keen for regional anaesthesia
  • Spinal vs Local infiltration discussed, consensus opinion that either would be a suitableanaesthetic


  • Proceed to surgery
  • Discuss meeting outcomes with surgeon
  • Refer to HIPS for chronic pain management