The Impact of Sugammadex on Ileus After Abdominal Wall Reconstruction

Eligibility Criteria

• * Adults \>18 years old
• * Patients requiring an open ventral hernia repair with retromuscular mesh placement and at least one myofascial advancement flap
• * Hernias with fascial defects \< 20cm wide
• * Non-emergent cases
• * Known serious or severe hypersensitivity reaction to sugammadex or any of the ingredients in sugammadex.
• * Hernias with fascial defects \> 20cm wide
• * Concomitant treatment with a strong or moderate cytochrome P450 3A4 inhibitor (e.g., Ketoconazole and other anti-fungals, Clarithromycin, HIV protease inhibitors, diltiazem, erythromycin, verapamil) or strong CYP3A4 inducers (e.g., rifampin).
• * Known small bowel obstruction (SBO) at the time of hernia repair
• * Suspected SBO or at risk of recurrent SBO at the time of hernia repair - at the discretion of the staff surgeon.
• * Nasogastric (NG), orogastric (OG), or gastric (eg. PEG) in place at the time of hernia repair and left in beyond the morning of the first postoperative day.
• * Patients with a stoma.
• * Cancer with increased risk of gastro-duodenal perforation (e.g., infiltrative gastrointestinal tract malignancy, recent gastrointestinal tract surgery, diverticular disease including diverticulitis, ischemic colitis, or concomitantly treated with bevacizumab) - at the discretion of the staff surgeon.
• * Disorder that could alter the integrity of the gastrointestinal lining (e.g., Crohn's disease) - at the discretion of the staff surgeon.
• * Severe hepatic failure (Child-Pugh Class C).
• * Clinically relevant hepatic failure (e.g. cirrhosis) - at the discretion of the staff surgeon.
• * Severe renal failure (GFR\<30ml/min, on dialysis, or have an arteriovenous fistula, indwelling hemodialysis catheter or peritoneal dialysis catheter) - at the discretion of the staff surgeon.
• * Pregnant or planning to become pregnant during study period.
• * Breastfeeding or planning to breastfeed during study period.
• * Clinically relevant alteration of the blood-brain-barrier - at the discretion of the staff surgeon.
• * Other contraindication to sugammadex as documented by a physician.
• * Unable to give informed consent; vulnerable populations; non-English speaking.
• * Emergent operation.
• * Undergoing minimally invasive approaches.
• * Undergoing repair with mesh placed in a position other than retromuscular.
• * Chronic opioid users, as defined by the daily use of opioids for at least 90 days within the past year
• * Inability to safely extubate the patient at the end of the surgery for any reason, as determined by the operative team.