What is the position of the patient in hernia surgery?

September 24, 2025 •

4 min read

Millions of hernia surgeries are performed annually, and a key factor for a successful outcome is understanding what is the position of the patient in hernia surgery. The correct positioning, determined by the type of hernia and surgical approach, is vital for surgical access, patient safety, and optimal outcomes.

Quick Summary

For hernia surgery, the patient is typically placed in a supine position, flat on their back, but adjustments like the Trendelenburg tilt are common for laparoscopic procedures to use gravity to aid the surgeon.

Key Points

Standard Supine Position: Most hernia surgeries start with the patient lying flat on their back, which is the supine position.
Trendelenburg for Laparoscopic Inguinal Repair: For laparoscopic inguinal hernias, the operating table is tilted head-down (Trendelenburg) to use gravity to move abdominal organs away from the surgical area.
Reverse Trendelenburg for Hiatal Hernia: In hiatal or upper abdominal hernia repairs, the patient is placed in a head-up tilt (Reverse Trendelenburg) for better access to the diaphragm.
Patient Safety is Key: Regardless of the position, extensive padding and careful securing are used to protect nerves and prevent pressure injuries.
Position Varies by Hernia Type: The optimal patient position is determined by the specific type and location of the hernia, as well as the surgical technique being used.

Understanding the Foundational Supine Position

The most common starting position for nearly all types of surgery, including many hernia repairs, is the supine position. In this arrangement, the patient lies flat on their back facing upwards. The head, neck, and spine are kept in a neutral position, and padding is strategically placed under the head, elbows, and heels to prevent pressure injuries and nerve damage. The arms are typically tucked at the patient's sides or abducted on armboards at an angle less than 90 degrees to protect the brachial plexus from injury.

For an open hernia repair, such as a traditional inguinal or ventral hernia repair, the surgeon can usually operate with the patient remaining in this simple supine position. It offers excellent access to the abdominal region and is a stable, comfortable position for the patient throughout the procedure.

The Gravity Advantage: Specialized Positions for Laparoscopic Surgery

When a minimally invasive or laparoscopic approach is used for hernia repair, the patient's position is often adjusted to provide the surgeon with better visualization and access. This technique, which involves inserting a camera and surgical instruments through small incisions, relies on gravity to move internal organs away from the surgical site.

The Trendelenburg Position for Inguinal Hernias

For a laparoscopic inguinal hernia repair, the patient is placed in the Trendelenburg position. This involves tilting the operating table so that the patient's head is lower than their feet. A typical angle is around 15 to 20 degrees. The primary purpose of this tilt is to allow gravity to pull the abdominal organs, specifically the intestines, away from the pelvis and groin area. This creates a clearer operative field for the surgeon, making it safer and more efficient to complete the repair. To prevent the patient from sliding, shoulder braces or special non-slip mattresses are used, and pressure points are carefully padded.

The Reverse Trendelenburg for Upper Abdominal Hernias

Conversely, for hiatal or some upper abdominal hernia repairs, the reverse Trendelenburg position is employed. In this orientation, the head of the bed is tilted upwards, raising the patient's head above their feet. This allows gravity to pull the abdominal organs downwards, providing better access and visibility for the surgeon working near the diaphragm and stomach.

Comparison of Patient Positions for Hernia Surgery


Feature	Supine Position	Trendelenburg Position	Reverse Trendelenburg Position
Surgical Approach	Primarily Open	Laparoscopic (Inguinal, Pelvic)	Laparoscopic (Hiatal, Upper Abdominal)
Table Tilt	Flat (0 degrees)	Head-down tilt (approx. 15-20°)	Head-up tilt (approx. 15-30°)
Purpose	Standard access to abdominal wall	Use gravity to retract abdominal contents from pelvis	Use gravity to retract organs from upper abdomen
Primary Hernia Types	Inguinal, Ventral	Inguinal, Femoral	Hiatal, Epigastric
Safety Considerations	Padding for pressure points	Non-slip surface, shoulder braces	Padding for posterior calcaneus

The Critical Role of Patient Safety and Comfort

While achieving optimal surgical access is a priority, ensuring the patient's safety and comfort is paramount throughout any procedure. The anesthesia team works closely with the surgeons to manage the patient's positioning and prevent potential complications. This includes:

Padding and Support: All bony prominences (e.g., elbows, heels, occiput) are padded with gel or foam cushions to prevent pressure ulcers and protect nerves.
Securing the Patient: Straps are used to safely secure the patient to the operating table, particularly during table tilts, preventing accidental movement or falls.
Monitoring: The patient's vital signs are continuously monitored, and adjustments are made as needed, especially during maneuvers like the Trendelenburg position, which can cause temporary physiological changes.

Specialized Patient Positioning for Specific Hernias

Beyond the standard positions, slight modifications may be necessary depending on the location and complexity of the hernia:

Umbilical Hernia: Often repaired with the patient in the standard supine position, as the location is easily accessible. The abdominal wall is prepped and draped to allow for a clear view of the area around the navel.
Incisional Hernia: The patient is typically supine. The surgeon must carefully prepare the area around the incision site, which is often in the midline of the abdomen. The size and location of the previous incision may influence the exact placement of the surgical tools, especially in laparoscopic cases.
Hiatal Hernia: These are repaired laparoscopically with the patient in the reverse Trendelenburg position to use gravity to pull the stomach and other contents away from the diaphragm, where the hernia is located.

The Interdisciplinary Effort of Positioning

Correct patient positioning is not a task for a single individual but a collaborative effort involving the surgeon, anesthesiologist, and surgical nursing staff. They assess the patient's specific needs, medical history, and the requirements of the procedure to determine the safest and most effective position. This teamwork ensures that surgical site access is maximized while risks such as nerve injury, pressure damage, and circulatory issues are minimized.

For more information on safe surgical practices and patient safety, review guidelines from a reputable medical organization like the American College of Surgeons.

Conclusion

The position of the patient in hernia surgery is a critical decision that directly impacts the success and safety of the procedure. While the standard supine position is common for open repairs, specialized tilts like Trendelenburg and Reverse Trendelenburg are essential for achieving optimal visualization and access during laparoscopic procedures. This meticulous approach to patient positioning, coupled with careful monitoring and padding, is a testament to modern surgical practice's commitment to patient safety and positive surgical outcomes.

Frequently Asked Questions

The most common starting position is the supine position, where the patient lies flat on their back. However, this may be adjusted depending on the specific type of hernia and the surgical approach.

The Trendelenburg position, with the patient's head lower than their feet, is used primarily in laparoscopic inguinal hernia repair. It leverages gravity to pull the abdominal organs out of the pelvis, giving the surgeon a clearer view of the operative field.

Yes. While an open repair can often be performed with the patient remaining in a simple supine position, a laparoscopic repair often requires adjusting the table into a Trendelenburg or Reverse Trendelenburg position to improve surgical access.

The Reverse Trendelenburg position involves tilting the table to raise the patient's head above their feet. This is typically used for procedures on the upper abdomen, such as hiatal hernia repair, to move internal organs downwards.

Patient safety is ensured through meticulous padding of all pressure points, careful strapping to prevent sliding, and continuous monitoring of vital signs. The surgical team works together to prevent complications like nerve damage.

Yes, the type of hernia is a major factor. For example, an inguinal hernia might require the Trendelenburg position, while a hiatal hernia necessitates the Reverse Trendelenburg position to provide optimal access for the surgeon.

During surgery, the patient's arms are carefully positioned and padded. They are either tucked at the patient's sides or placed on armboards at a specific angle (less than 90 degrees) to prevent nerve compression.