DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Left hydrocele, possible right.
2. Urethral meatal stenosis.
POSTOPERATIVE DIAGNOSES:
1. Left hydrocele.
2. Urethral meatal stenosis.
OPERATIONS PERFORMED:
1. Left hydrocelectomy.
2. Diagnostic laparoscopy.
3. Urethral meatoplasty.
ANESTHESIA: General and caudal.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and general anesthesia was administered. Caudal block was administered. The patient was then positioned supine and prepped and draped in the usual sterile manner. A left inguinal skin crease incision was made and the dissection proceeded to expose the external oblique fascia. After placing self-retaining retractors, the external oblique was opened in the direction of its fibers. The external ring was opened. The ilioinguinal nerve was identified and moved away to avoid any injury. The cord was then isolated and a vessel loop placed around it. The fibers of cord were separated and hydrocele sac was identified. This was carefully dissected away from the cord structures, taking care to identify and avoid any injury to the vas or vessels.
Once the sac was completely isolated, bladder was doubly clamped and divided on the proximal aspect as well as up to the internal ring. The sac was then opened, 5 mm laparoscopic trocar sheath was placed under vision into the peritoneum, and a 2-0 silk stitch was secured in order to maintain the pneumoperitoneum. CO2 was then insufflated to a pressure of 10 mmHg. With the patient in Trendelenburg position, the contralateral internal ring was inspected with a 25 degree lens. The vas and vessels were seen exiting a closed internal ring. Thus, a repair on the right was required. The scope was removed, pneumoperitoneum was released, and the trocar was removed. The hydrocele sac was gathered in the right-angled clamp, twisted, and high ligation was performed with 3-0 Vicryl suture ligature and tied.
Attention was turned to the distal aspect of the sac and the testis was delivered. Tunica vaginalis was opened, redundant tunica was excised, hydrocele fluid drained. A very small testicular appendage was also excised with cautery. The testis was then returned to its normal scrotal location. The floor of the canal was inspected, and there was no evidence of any weakness to suggest a direct hernia. The external oblique was then closed with a running 3-0 Vicryl, taking care to avoid any injury to the nerve. The subcutaneous tissues were closed with interrupted 4-0 chromic, and the skin with running 4-0 Monocryl. Steri-Strip and Tegaderm dressing were placed over the inguinal incision.
Attention was now turned towards the urethral meatus and the tissue in the ventral midline. The meatus was stenotic, so the tissue in the ventral midline was crushed with a mosquito clamp and then opened sharply with Westcott scissors. A 7-0 Vicryl stitch was placed at the apex. Some redundant tissue was crimped and then excised along either the left or right side. To make a normal appearance and help with avoiding interrupting the stream, this tissue was excised. The edge of the urethral mucosa was attached to the glans skin. This was done also with 7-0 Vicryl sutures. Bacitracin ointment was placed over the meatus. The patient was awakened. He was taken to the recovery room in stable condition. All counts were correct. He tolerated the procedure well. There were no complications.
