DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left inguinal hernia.
POSTOPERATIVE DIAGNOSIS: Left inguinal hernia.
OPERATION PERFORMED: Left inguinal hernia repair with mesh.
SURGEON: John Doe, MD
ANESTHESIA: Local/MAC.
DRAINS: None.
TUBES: None.
SPECIMENS: None.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Minimal.
POSTOPERATIVE CONDITION: Stable.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old male with a symptomatic left inguinal hernia, who now presents for left inguinal hernia repair with mesh under local/MAC anesthesia.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and laid on the table in the supine position. Following adequate IV sedation, the lower abdomen was prepped and draped in the usual sterile fashion. Following this, a left inguinal incision was made, and dissection was carried down to the level of the external oblique. External oblique fibers were completely cleared off and then the external oblique was opened in the direction of its fibers through the level of the external ring.
Following this, a straight hemostat was placed on both sides of the external oblique, and careful blunt dissection was performed to completely encircle the cord and its contents at the level of the pubic tubercle. Penrose drain was placed around the cord and then the cremasteric fibers were divided off of the cord. An indirect hernia sac was identified on the anteromedial portion of the cord, and this was carefully dissected off of the cord structures and reduced back to the level of the peritoneum. The hernia sac was not large. There was, however, large cord lipoma, and this was dissected off the cord and reduced back into the preperitoneal space. Therefore, the patient had an indirect inguinal hernia.
A large polypropylene mesh plug was placed into the indirect defect and sutured into place with 0 Ethibond pop-off sutures. Following this, a polypropylene keyhole mesh with an end slit was sutured into the wound. It was sutured to the strong tissue on top of the pubic tubercle, laterally was sutured to the shelving edge of the inguinal ligament, again using interrupted 0 Ethibond pop-off sutures. Medially, it was sutured onto the rectus muscle in an onlay fashion. The internal ring was reconstituted by placing a suture just cephalad to the cord structures and then the tails were sutured to the anterior abdominal wall.
Meticulous hemostasis was ensured. More local anesthetic was injected, and the external oblique was reapproximated using interrupted 3-0 Vicryl pop-off sutures. Scarpa’s layer was also approximated using interrupted 3-0 Vicryl pop-off sutures as was the deep dermis. The skin was closed using running 4-0 Monocryl subcuticular stitch. Benzoin and Steri-Strips were applied along with dry dressing and Tegaderm, and the patient tolerated the procedure well.
