DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Recurrent right inguinal hernia.
POSTOPERATIVE DIAGNOSES: Undescended right testicle, chronic and recurrent right inguinal hernia.
1. Right inguinal exploration, open technique.
2. Right orchiectomy.
3. Mesh repair, recurrent right inguinal hernia.
SURGEON: John Doe, MD
ANESTHESIA: General with 0.5% Marcaine, 30 mL.
ESTIMATED BLOOD LOSS: Approximately 10 mL.
DESCRIPTION OF OPERATION: The patient received IV antibiotics for prophylaxis, SCDs for DVT prophylaxis, Foley catheter intraoperatively. Under satisfactory general anesthesia, the abdomen was prepped and draped in the usual sterile fashion. A right inguinal incision was made through the skin and subcutaneous tissues. External oblique aponeurosis was incised and opened to the external ring, which immediately revealed a chronic undescended right testicle. Finger palpation toward the scrotum revealed no opening, and the spermatic cord was extremely thickened with a thickened hernia sac surrounding, measuring approximately 6 to 8 mm in thickness.
Due to the chronicity of the undescended testicle and the risk of testicular malignancy, orchiectomy was indicated. Distally, the gubernaculum was ligated with 2-0 Vicryl and divided. Proximally, the cord vessels and vas deferens were doubly ligated with 0 Vicryl and divided and specimen sent for pathologic evaluation. The thickened hernia sac was transected over a GIA stapler and the staple line oversewn with running 0 Vicryl suture. Mesh repair was then performed with Marlex suturing medially to pubic tubercle and Cooper ligament. Transition suture to the shelving edge of the inguinal ligament was performed. Medially, the mesh was sutured to the transversalis fascia and 0.5% Marcaine was infiltrated for local postoperative analgesia, and the external oblique was closed anterior with running 2-0 Vicryl. Scarpa fascia was closed with 3-0 Vicryl, and skin was closed with 4-0 Vicryl. Steri-Strips and bandage applied.
The patient tolerated the procedure well without complications and returned to the recovery room in satisfactory condition. All sponge, needle and instrument counts were correct following the procedure. The patient was discharged home with local wound care instructions and oral analgesics.