DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Large incarcerated ventral incisional hernia with possible strangulation.
POSTOPERATIVE DIAGNOSIS: Large incarcerated ventral incisional hernia, including large and small bowel as well as omentum, with vascular congestion and early strangulation.
OPERATION PERFORMED:
1. Reduction of incarcerated ventral incisional hernia with release of large bowel, small bowel, and omental incarceration and early strangulation.
2. Partial omentectomy.
3. Ventral incisional herniorrhaphy.
SURGEON: John Doe, MD
ANESTHESIA: General.
COMPLICATIONS: Vascular congestion and early strangulation of bowel with associated edema.
DESCRIPTION OF OPERATION: The patient is a (XX)-year-old male brought to the operative suite, administered general inhalation anesthesia, and prepped and draped in the usual sterile manner utilizing Betadine solution. The bladder and stomach had been emptied. A ventral incisional hernia was quite obvious with incarceration. The old scar cicatrix was elliptically excised and removed. Bleeding points were controlled with electrocautery. Dissection continued to the hernia sac, which was carefully dissected back to the hernial ring, which was quite tight. The fascia around the entire hernial ring was cleaned and then the hernia sac was opened. The hernia was quite large and contained the entire right colon, approximately one-half of the transverse colon, a large loop of small bowel demonstrating vascular congestion, and several large segments of omentum. This rather large hernia was remarkable through the rather small hernial opening.
We were unable to reduce these masses back through the hernial defect. Several segments of the omentum were removed utilizing Kelly clamps and utilizing 2-0 Vicryl ties across the base of the omentum. Even with the omentum removed, we were still unable to reduce the congested small bowel and colon back through the hernial defect. The fascia of the defect was now incised in both directions to open the hernial defect. This allowed reduction of the small bowel back into the abdominal cavity and allowed us also to return the transverse and right colon to their normal positions. The colon maintained its color. The small bowel initially showed vascular congestion and was dusky; however, with warm towels, it pinked up quite nicely, showing normal color and peristalsis demonstrating viability.
With this now completed, the wound was irrigated with normal saline solution as was the abdominal cavity. The saline was aspirated. A large 18 x 14 cm Kugel Composix mesh was chosen for repair of this defect, and it was placed in position and allowed to open in a normal manner. The fascia was attached to the anterior leaflet of the Kugel Composix mesh circumferentially utilizing 0-PDS suture. With this accomplished, the stapling device was utilize to fixate the mesh to the anterior abdominal wall circumferentially, just medial to the retaining ring of the mesh sheath.
With this now completed, the wound and mesh were irrigated with normal saline solution and aspirated until clear. The subcutaneous tissue was approximated utilizing running 3-0 Vicryl suture. Skin edges were approximated utilizing stainless steel staples. Sterile Tegaderm and fluff dressings were applied and secured in place. He tolerated the procedure nicely and was returned to the recovery room in satisfactory condition.
