DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Symptomatic incisional ventral hernia, status post appendectomy.
POSTOPERATIVE DIAGNOSIS:
Symptomatic incisional ventral hernia, status post appendectomy.
OPERATION PERFORMED:
Laparoscopic incisional ventral herniorrhaphy with mesh.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General with endotracheal intubation.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: This (XX)-year-old female presents with a symptomatic incisional ventral hernia at the site of her previous appendectomy. The patient was evaluated and felt to be a candidate for general anesthesia for surgery. The plan is to proceed with a laparoscopic ventral hernia repair. The procedure, including risks and potential complications such as bleeding, infection, enterotomy, infection of the mesh, as well as a possibility of recurrence, was discussed with the patient. The possible need for further surgery was discussed with the patient. The patient understood and agreed with the plan.
OPERATIVE FINDINGS: The patient had extensive adhesions in the right lower quadrant associated with the right lower quadrant fascial defect. This was at the site of her previous appendectomy. There was approximately a 4 x 3 cm fascial defect.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and laid in a supine position. Appropriate monitors were applied, and the patient was intubated and general anesthesia was achieved. The patient’s abdomen was prepped and draped in a sterile fashion.
An incision was made in the left upper quadrant. Veress needle was placed. Then, using a 12 mm bladeless trocar with the laparoscope in place, the abdomen was entered with the laparoscope visualizing the entrance. This was done without difficulty. Diagnostic laparoscopy was performed. An additional 5 mm bladeless trocar was placed in the left lower quadrant. An additional 10/11 bladeless trocar was placed in the right upper quadrant.
The patient was placed in Trendelenburg position with the patient tilted with her left side down, right side up. Adhesiolysis was performed, taking omental adhesions off the abdominal wall in the midline. There were no fascial defects noted in the midline incision. Once these adhesions were taken down, the areas were inspected. There was no dissection or any visceral structures. The hernia sac had some adherent small bowel associated with the previous appendectomy as well as some omentum. The hernia sac was reduced into the abdominal cavity, and the hernia sac grasped. These structures were dissected off the hernia sac on the adhesions with care taken not to dissect directly on the visceral structures. The entire area was freed up. The adhesions to the sac were freed up circumferentially. The fascial defect was cleared of tissue. Pictures were taken. It was measured to be approximately a 4 x 3 cm fascial defect. A piece of Bard composite mesh, approximately 10 x 15 cm, was chosen. It was laid on the proper longitudinal axis. This overlapped the fascial defect circumferentially, adequately.
Next, 0 Vicryl sutures were placed on the mesh. The mesh was placed into the abdomen, and Vicryl sutures were used to pull the mesh up against the abdomen wall taught. Then, the mesh was tacked to the abdominal wall circumferentially using the Onyx tacker. This was done at approximately 1 cm intervals on the outer ring and then internally as well. The mesh overlapped the fascial defect adequately throughout the entire area.
Satisfied with the repair of the area, a diagnostic laparoscopy was performed. There was no abnormal fluid collection or any active bleeding noted. Satisfied with the repair, the procedure was then completed. Pneumoperitoneum was released. The skin was closed using 4-0 Vicryl in subcuticular fashion. Port sites were infiltrated with 0.5% Marcaine with epinephrine. Steri-Strips were applied and sterile dressing. The patient tolerated the procedure well without any complications.
