DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Incarcerated umbilical hernia.
POSTOPERATIVE DIAGNOSIS: Incarcerated incisional hernia.
OPERATION PERFORMED: Repair of incarcerated incisional hernia with mesh.
SURGEON: John Doe, MD
ANESTHESIA: Lidocaine 1% with epinephrine along with 0.25 % Marcaine local infiltration.
DESCRIPTION OF OPERATION: The patient was placed in the supine position on the operating table. The central abdomen was prepped with Betadine and draped in the usual manner. The patient had a surgical scar at the lower lip of the umbilicus, probably from a previous laparoscopic tubal fulguration.
Curved incision, 3 cm long, was proposed along the lower half of the umbilical border. This area was infiltrated with 1% lidocaine with epinephrine. The incision was made in the skin and deepened through the subcutaneous tissues. Hemostasis was achieved with electrocautery. The hernial bulge was visualized and was dissected free from the undersurface of the umbilicus. There were two adjacent hernial bulges, which were adjacent to each other. They were dissected down to the fascial defect. The fascial defect was delineated. The herniated preperitoneal fat was dissected free from the fascial edge and then reduced after excising the excess. The bridge between the two fascial defects was divided and converted into a single 2 cm diameter fascial defect. There was a tiny fascial defect adjacent to this. The wound was irrigated with saline. The medium-sized ProLoop mesh plug was introduced within the fascial defect and sutured edges with horizontal mattress sutures of 0 Prolene. The tiny fascial defect was closed with a single Prolene suture. The wound was irrigated with saline. The patient had been given 1 gram of Kefzol. The patient was already on antibiotics, including vancomycin and Zosyn, and these were continued. The onlay patch was placed on top of the fascia and the plug. It overlapped the fascial defect for about 2 cm in all size. It was anchored to the fascia with 0 Prolene sutures.
The wound was irrigated with saline. Hemostasis was ensured. Marcaine 0.25% was infiltrated into all the layers prior to closure. The subcutaneous tissues were closed with interrupted 2-0 Vicryl sutures. The skin incision was closed with interrupted 3-0 Vicryl subcuticular sutures. Steri-Strips and dry sterile dressings were applied. Blood loss was minimal. Tape and instrument counts were reported correct. The patient tolerated the procedure well and was transferred to the recovery room in good condition.
