DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Recurrent right inguinal hernia.
POSTOPERATIVE DIAGNOSIS: Indirect recurrence of right inguinal hernia.
OPERATION PERFORMED: Repair of indirect right inguinal hernia recurrence with mesh.
SURGEON: John Doe, MD
ANESTHESIA: General via endotracheal tube.
DRAINS: None.
SPECIMENS: None.
TUBES: None.
ESTIMATED BLOOD LOSS: Less than 10 mL.
COMPLICATIONS: None.
POSTOPERATIVE CONDITION: Stable to PACU.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old female who previously underwent a repair of a right inguinal hernia approximately eight years ago. Over the last six months to one year, she has noticed an increasing bulge in her right groin. On physical exam, this was consistent with a recurrence of her right inguinal hernia. She also has been seeing Dr. Jane Doe and required a hysterectomy and repair of rectocele. We scheduled this as a combined procedure.
DESCRIPTION OF OPERATION: Dr. Jane Doe’s team completed their portion of the case. At the completion of the case, we entered the operating room. The patient was placed supine on the operating room table. The abdomen was clipped of hair. The right lower quadrant was then prepped with DuraPrep and draped in the standard sterile fashion, including an Ioban drape. A new set of instruments were used for this operation, and an additional 1 gram of Ancef IV was administered prior to the skin incision.
A time-out was held. The patient, the planned procedure, and the consent form were confirmed with all of those present. The patient’s previous right lower quadrant skin crease incision was reopened. This was taken down through the subcutaneous tissue to the external oblique. The external oblique was opened along its fibers. Dissection was carried out underneath the external oblique, which revealed the conjoined tendon underneath. The right internal inguinal ring was noted. This was noted to be dilated and would easily admit an index finger tip. The inguinal floor was searched for any further evidence of recurrence, and there was none. It appeared that the recurrence was at the level of the internal ring, again which was not dilated. The round ligament had previously been transected and included in the repair. We examined the floor of the canal. We did not feel that the internal ring was dilated to the point where it would require a plug to repair it.
We then elected to carry out a repair by directly obliterating the right internal ring with permanent suture of 0 Ethibond. This closed this in a shutter-like fashion. The repair of the indirect hernia was then completed with Prolene mesh. This was brought up on the table, cut to size, and was sutured to Cooper’s ligament inferior and medially, the shelving edge of the inguinal ligament, then laterally. It was also sutured to the conjoined tendon superior and medially and then superior and laterally. This was done without excessive tension and was done to allow just a slight laxity.
The wound was then checked meticulously for hemostasis, and excellent hemostasis was obtained. The wound was then irrigated copiously with saline and rechecked for hemostasis. After no further bleeding was found, the wound was closed in layers with 3-0 Vicryl in the external oblique, 3-0 Vicryl in Scarpa’s fascia, and a 4-0 running Monocryl in the skin. The wound was dressed with Dermabond. The patient tolerated the procedure well, and she was transferred to the recovery room under the care of Anesthesia and surgical staff at the termination of the case. Needle, sponge, and instrument counts were correct as reported to me by the nurse in charge at the termination of the case. There were no complications.
