DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Ventral incisional hernia.
POSTOPERATIVE DIAGNOSIS: Ventral incisional hernia.
PROCEDURE PERFORMED: Repair of ventral incisional hernia using polypropylene mesh.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: 25 mL.
COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: The patient was transported to the operating room and placed supine on the operating table. Following induction of satisfactory general endotracheal anesthesia, the abdomen was prepped and draped in the customary fashion using iodine solution, Ioban drape, and sterile towels and sheets.
A skin incision was made along the right costal margin, overlying the palpable bulge and the dissection carried into the subcutaneous tissue. All bleeding points were controlled with Bovie electrocautery. The hernia sac was identified and using sharp dissection was mobilized from the surrounding soft tissue of the abdominal wall, down to the level of the anterior fascia. The hernia appeared to involve the majority of her previous right subcostal incision. The fascial edges were then cleaned circumferentially for a distance of at least 3-4 cm. The hernia sac was opened and any adherent omentum was mobilized sharply and returned back to the abdominal cavity. The midline fascia was palpated superiorly and inferiorly to ensure that there were no other defects. Finding none, a retromuscular extraperitoneal plane was developed including mobilization of the posterior rectus sheath. This dissection extended to at least 4 cm beyond the margins of the fascial opening. The excess hernia sac was excised and the posterior sheath and peritoneum closed with running 2-0 PDS suture.
Next, an appropriate sized piece of polypropylene mesh was used to repair the fascial defect. This was placed in the retromuscular extraperitoneal space and extended at least 4 cm beyond the margins of the fascial opening. The mesh was secured in place with full thickness horizontal mattress sutures of 0 Prolene. Additional mattress sutures of 0 Prolene were placed along the margins of the fascial opening.
At the completion of the repair, the fascial defect was well covered with mesh without evidence of tension. The area of dissection was thoroughly irrigated with Kantrex solution and checked for hemostasis. A 7 flat Jackson-Pratt drain was introduced through a separate stab incision and positioned in the deep subcutaneous space. This was secured to the skin with 2-0 silk suture. The subcutaneous tissue was closed with interrupted 3-0 Vicryl sutures and 0.5% Marcaine instilled into the incision. The skin was closed with running 4-0 Vicryl subcuticular suture. Benzoin and Steri-Strips as well as a Tegaderm dressing were placed across the incision. The Jackson-Pratt drain was connected to closed suction. The patient was then awakened and transported back to the recovery room in satisfactory condition with sponge and needle counts reported as correct at the end of the procedure.
