The Impact of Sugammadex on Ileus After Abdominal Wall Reconstruction

Inclusion 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 Exclusion Criteria: 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.