DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Bilateral inguinal hernia.
POSTOPERATIVE DIAGNOSIS: Bilateral inguinal hernia, direct.
OPERATION PERFORMED: Laparoscopic bilateral inguinal hernia repair.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: Minimal.
DESCRIPTION OF OPERATION: With the patient under general endotracheal anesthesia, the abdomen was prepped with ChloraPrep solution and draped in the usual manner.
A transverse skin incision was made below and to the right of the umbilicus to a length of approximately 4 cm. The incision was carried through the subcutaneous tissue. Bleeders were cauterized. The right rectus sheath was identified and incised lateral to the midline. The preperitoneal space was then developed following insertion of a Spacemaker balloon, which was inflated under direct vision.
Following removal of the Spacemaker balloon, a #10 trocar was placed in the preperitoneal space and the preperitoneal space was insufflated with CO2. Two #5 trocars were placed in the lower midline. Video laparoscope was inserted in the preperitoneal space. Landmarks including symphysis pubis, right Cooper ligament and right inferior epigastric vessels were identified. Dissection was then continued lateral to the transverse abdominis muscle. The internal ring was then explored for the presence of an indirect hernia sac. No indirect hernia sac was identified. The patient had a cord lipoma, which was reduced under direct vision. Exploration of the medial space showed a medial defect suggesting a direct hernia. A large size Bard 3D mesh was placed in the preperitoneal space and anchored to the symphysis pubis and anterior abdominal wall along the upper edge of the mesh with a stapler. The lower edge of the mesh was affixed to the abdominal wall with Tisseel fibrin glue.
Following this, the left preperitoneal space was explored in the same fashion. Landmarks including symphysis pubis, Cooper ligament and inferior epigastric vessels were identified. The dissection was continued laterally to the transverse abdominis muscle. The internal ring was then explored for the presence of an indirect hernia sac. No indirect hernia sac was identified. A cord lipoma was reduced. The patient was found to have a medial defect suggesting a direct hernia. A large size left 3D Prolene mesh was then placed in the preperitoneal space and placed over the floor of the inguinal canal and stapled to the symphysis pubis and anterior abdominal wall along the upper edge of the mesh with a stapler.
The lower edge was anchored to the abdominal wall with Tisseel fibrin glue. The preperitoneal space was then deflated. All trocars were withdrawn. The defect in the rectus sheath was closed with figure-of-eight 0 Vicryl suture. The skin incisions were closed with subcuticular 5-0 Monocryl suture. Sterile dressings were then applied. The patient tolerated the procedure well and was brought to the recovery room in stable condition. Needle and sponge counts were correct.
