DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Ventral hernia.
POSTOPERATIVE DIAGNOSIS: Ventral hernia.
OPERATION PERFORMED: Mesh repair of a very large ventral hernia.
SURGEON: John Doe, MD
ANESTHESIA: General anesthesia with endotracheal tube intubation.
SPECIMEN: None.
DRAINS: 10 French flat Jackson-Pratt drains were placed above the Dual Mesh, both in the lateral positions of our dissection.
ESTIMATED BLOOD LOSS: Approximately 50 mL.
INTRAOPERATIVE FINDINGS: A very large ventral hernia was easily identified from the previous removal of the patient’s rectus abdominis muscle. The defect was extended from just below the xiphoid process all the way to the pubic symphysis. The diameter was approximately 5-6 inches across. Not one time during the course of dissection, did we enter the peritoneal cavity. We were able to circumferentially undermine the subcutaneous tissues with visualization of good fascia for 360 degrees.
INDICATION FOR PROCEDURE: This (XX)-year-old Hispanic male has developed a ventral hernia in the site of a previous operation removing his rectus abdominis muscle for placement of a myocutaneous flap from a previous above-the-knee amputation. The patient has done well but has become symptomatic from this very large ventral hernia and has elected to go ahead and get a repair performed. The operative consent was signed and placed upon the chart. All the risks, benefits, and alternatives of the procedure were described in detail. Preoperative antibiotics were given.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed in the supine position. Bilateral lower extremity athrombics were placed. General anesthesia was induced. The anterior abdominal wall was then prepped and draped in the usual sterile fashion.
A vertical midline incision, incorporating the old incision, was then made. A portion of the old scar was then completely excised. The incision was then deepened through the fascia. The hernia sac was identified and dissected free in a circumferential fashion. The peritoneum of the hernia sac could be easily identified, and not at one time during the course of our dissection did we enter this. The fascia was then carefully palpated, and there were no additional defects, which were identified. We then continued to complete our dissection with visualization of good fascia in a circumferential manner.
A piece of Dual Mesh, approximately 26 x 10 cm, was then tailored to fit the defect and sutured to the fascial edges with simple interrupted sutures of 0 Ethibond multiple times. There was a slight fold present within the Dual Mesh that was excised, and this defect was then reapproximated with a running 0 Prolene suture.
After this was performed, the subcutaneous tissues were then copiously irrigated with warm normal saline and siphoned free. Closed suction drains were then placed, those being 10 French flat Jackson-Pratt drains placed in the lateral gutters, which we had undermined. Both drains were then anchored into place with 3-0 silk sutures. Drains were then hooked to bulb suction.
Subcutaneous tissues were then closed with a running 3-0 Vicryl suture. The skin was then closed with skin staples. The incision was cleaned and dried along with the application of a dry sterile dressing and Medipore tape. The patient tolerated the procedure well and was brought to the postanesthetic care unit in stable condition. All instrument, sponge, and needle counts were correct at the end of the case.
