DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Umbilical hernia.
POSTOPERATIVE DIAGNOSIS:
Incarcerated umbilical hernia.
OPERATION PERFORMED:
Mesh repair of incarcerated umbilical hernia.
SURGEON: John Doe, MD
ANESTHESIA: General via laryngeal airway mask and local.
PACKS: None.
DRAINS: None.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: 5 mL.
INDICATIONS FOR OPERATION: This is a (XX)-year-old female with a history of an umbilical hernia. On physical examination, there is a partially reducible umbilical hernia that is nontender. The patient’s physical examination is, otherwise, noncontributory. The patient has not had any complications with respect to this hernia, including obstructive symptoms. The patient was informed of the procedure and the risk factors involved. The patient understood and wished to proceed. Informed consent was obtained.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed on the table in the supine position. She was given a dose of IV antibiotics. Venodyne compression stockings were placed. She was then placed under general anesthesia via laryngeal airway mask.
The patient’s abdomen was prepped and draped in a sterile fashion. A curvilinear incision was made about the lower half of the umbilicus extending less than 1 cm in either direction on the sides of the umbilicus at 3 and 9 o’clock. The incision was carried down to the subcutaneous tissue and dermis with scalpel. The dissection proceeded all the way down to the hernia contents and circumferentially around the hernia through a combination of blunt and sharp dissection with the scalpel. Dissection extended down to the fascial defect, which was circumferentially dissected, incising all attachments between the incarcerated hernia and the adjacent fascial defect. The fascial defect was subsequently found to measure approximately 13 mm in diameter. It contained incarcerated preperitoneal fat, omentum and hernia sac. All of the contents were successfully reduced into the preperitoneal space.
Circumferential dissection beneath the fascia was performed with blunt dissection. A flat piece of Marlex mesh was then trimmed to an appropriate oval size and deployed in the preperitoneal space. The fascial edges of the defect were then reapproximated with three interrupted figure-of-eight 0 Prolene sutures. The sutures were tied and then the knots were tied to each other and tacked down with 4-0 Vicryl so as not to push into the overlying skin. Hemostasis was examined for and achieved. Local anesthetic was infiltrated into the wound both beneath the fascial repair and into the soft tissue surrounding the fascia and open wound.
A total of 29 mL of 0.5% Marcaine with epinephrine was utilized. The dead space in the depth of the wound was then closed with interrupted 4-0 Vicryl. Deep dermis was reapproximated with interrupted 4-0 Vicryl and 5-0 Monocryl. The wound was examined and noted to be nice cosmetically. There were no defects in the overlying skin. The skin was cleansed and then dressed with tincture of benzoin, Steri-Strips, dry gauze, and Tegaderm. Sponge, needle and instrument counts were correct. The patient tolerated the procedure well. She was extubated postoperatively and transported to the recovery room in stable condition.
