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Repair of Umbilical Hernia Operative Example

DATE OF OPERATION:  MM/DD/YYYY

PREOPERATIVE DIAGNOSIS:
Umbilical hernia.

POSTOPERATIVE DIAGNOSIS:
Umbilical hernia.

OPERATION PERFORMED:
Open umbilical hernia repair with placement of mesh. 

SURGEON:  John Doe, MD

ASSISTANT:  None.

ANESTHESIA:  Carbocaine 2% local infiltration with IV sedation. 

FINDINGS:  The patient had a localized single umbilical hernia with preperitoneal fat.

DESCRIPTION OF OPERATION:  The patient was placed on the operating room table in the supine position. The periumbilical area was prepped and draped in the usual sterile manner. After adequate IV sedation was obtained, 2% Carbocaine was locally infiltrated.

An infraumbilical incision was made and carried down through the skin and subcutaneous tissue with the scalpel. Bleeding points were controlled with electrocautery device. Dissection of the subcutaneous tissue revealed the moderate size sac, which was adherent to the lower portion of the umbilicus. This was circumferentially dissected away from the fascia and also amputated from the base of the umbilicus. This was noted to contain preperitoneal fat and was totally reduced back into the defect. Blunt finger dissection cleared off the under surface of the fascia. 

A piece of PHS mesh system was then soaked in bacitracin antibiotic solution. The outer portion of the mesh was cut to proper size. The inner portion was left intact and placed into the preperitoneal space and then flattened out under direct visualization using forceps to flatten it underneath the fascial surface. The outer mesh was then laid flat over the abdominal wall and a running 0 Vicryl suture was used to suture the connecting neck to the ring of the actual defect itself.

At the end of this procedure, with the patient coughing and straining, the repair was noted to be intact. The area was irrigated out with bacitracin antibiotic solution. Hemostasis was noted to be good. The wound was closed with 3-0 Vicryl, and the subcutaneous tissue at the base of the umbilicus was tacked back down with a 3-0 Vicryl suture. The skin was closed with a running subcuticular 4-0 Vicryl suture. Steri-Strips and sterile dressing was applied.  The patient tolerated the procedure well and was taken back to the surgery center with stable vital signs.

DATE OF OPERATION:  MM/DD/YYYY

OPERATION PERFORMED:  Repair of umbilical hernia with mesh.

OPERATION IN DETAIL:  After adequate general anesthesia, the periumbilical region was shaved and sterilely prepped and draped in the usual manner.  The skin, deep tissue, and surrounding tissues around this hernia was infiltrated with the local anesthetic.

A curvilinear 3 cm infraumbilical skin incision was performed using #15 blade.  This was carried to the subcutaneous tissue.  The subcutaneous and deep tissues were bluntly dissected using a Kelly until the hernia sac was encountered.  This hernia sac was amputated from the fascial defect using Bovie cautery.  The preperitoneal fat attached to the sac was dissected and separated off the sac using cautery and reduced intra-abdominally.

Next, a small circular Ventralex mesh was opened, soaked in antibiotic solution and then placed in the subfascial through the fascial defect.  The fascia was approximately over the mesh, taking a bite of the mesh using #1 Prolene interrupted figure-of-eight.

Wound was irrigated with copious amount of antibiotic solution and then evacuated and inspected for bleeders and none were noted.  Deep subcutaneous was approximated using 3-0 Vicryl in interrupted fashion.  The skin was closed using 4-0 Vicryl continuous subcuticular fashion.  Steri-Strips were applied on the wound.  The sterile dressings were then applied.  All the instruments, lap, sponge, and needle counts were correct at the end of the case.

The patient tolerated the procedure well and was transferred to the recovery room in satisfactory condition.