DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Incisional ventral hernia, status post open Roux-en-Y gastric bypass procedure.
2. Abdominal pannus, chronic panniculitis status post weight loss.
POSTOPERATIVE DIAGNOSES:
1. Incisional ventral hernia, status post open Roux-en-Y gastric bypass procedure.
2. Abdominal pannus, chronic panniculitis status post weight loss.
OPERATION PERFORMED:
1. Incisional ventral herniorrhaphy.
2. Abdominal panniculectomy.
3. Abdominoplasty.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal intubation.
INDICATIONS FOR OPERATION: This is a (XX)-year-old male who presents with an incisional ventral hernia noted postoperatively after having undergone an open Roux-en-Y gastric bypass procedure. The patient also was noted to have a large abdominal pannus causing him to have problems with chronic panniculitis. The patient had lost approximately 150 pounds and had a resultant abdominal pannus. The patient presents for abdominal panniculectomy. The procedure including risks, benefits and potential complications as well as postoperative expectations were discussed with the patient. The patient understood and agreed with the plan.
OPERATIVE FINDINGS: The patient had a large abdominal pannus. There was a fascial defect in the mid portion of the abdominal wound. The fascial defect was approximately 1.5 cm in diameter. No other abnormalities were noted.
DESCRIPTION OF OPERATION: The patient was brought into the operating room and placed in the supine position. Once appropriate monitors were applied, the patient was intubated and general anesthesia was achieved. The patient had a Foley catheter placed. The patient’s abdomen was widely prepped and draped in sterile fashion. The patient was given a gram of Ancef. The patient had been marked in the preoperative holding area and was also marked on the table. An incision was made in the inferior abdominal fold underneath the pannus. This was taken through the crease on each side, which had been marked with the patient in standard position. This tear was taken from the fascia and it was then taken all the way up to costal margin on both sides. Care was taken to preserve the perforating vessels at the costal margin. During this dissection, the umbilicus and its blood supply were preserved.
Once this area was freed up, the facial defect was identified. It was closed using interrupted 0 Ethibond sutures. The fascial defect was only 1.5 cm in diameter. An abdominoplasty was then performed to repair the thinned out linea alba. This was started at the sternum and taken all the way down to the umbilicus and below the umbilicus also. This was done using interrupted figure-of-eight 0 Ethibond sutures. Satisfied with this, the entire wound was irrigated. Hemostasis was achieved with electrocautery. There was no active bleeding noted. At this point, the table was flexed and the wound closed using interrupted 0 Vicryl sutures to approximate the Scarpa fascia and 2-0 Ethibond sutures in an interrupted dermal fashion to close the skin. This was done starting in the midline and also starting laterally and moving towards the midline after the midline was set. During this dissection, the opposite site of the umbilicus was also marked prior to closing this wound.
A Blake drain was placed, one superiorly and one inferiorly from the most lateral aspect of the incision on both sides. These were secured with 2-0 nylon sutures. Once this was completed, an incision was made at the site where the umbilicus was marked. The umbilicus which has been marked for the proper orientation with the suture was brought out and closed using interrupted buried 4-0 Vicryl sutures. Steri-Strips were applied and sterile dressing. The patient tolerated the procedure well without complications. Estimated blood loss was approximately 150 mL. All instruments and sponge counts were reported correct x2. The patient was extubated and taken to the recovery room in stable condition.
