DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Umbilical fistula.
POSTOPERATIVE DIAGNOSES:
1. Infection of previously placed mesh for ventral herniorrhaphy.
2. Large preperitoneal abscess cavity.
OPERATION PERFORMED:
1. Attempted excision of umbilical fistula.
2. Excision of previously placed infected mesh.
3. Primary closure of abdominal wall.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
OPERATIVE FINDINGS:
1. Large preperitoneal abscess cavity measuring approximately 10 x 12 cm.
2. Infection of previously placed mesh for ventral herniorrhaphy.
DESCRIPTION OF OPERATION: The patient was brought from the holding area to the operating room, where he was placed on the operating room table in the supine position. After the patient was adequately sedated, local anesthetic was injected around what was presumed to be the umbilical fistula site.
A small, approximately 4 x 4 cm elliptical incision was made transversely around the presumed fistula. With a combination of blunt dissection and sharp dissection with electrocautery, this was dissected down to the anterior abdominal fascia. Once we began to clear this fascia and explore, what we presumed to be the base of this cavity, we soon recognized that the cavity extended subfascial.
The incision was extended medially and laterally to gain greater exposure. As we extended the incision, again a combination of blunt dissection and sharp dissection with electrocautery was used to dissect down to the base of the cavity. However, it quickly became apparent that we were dealing with a preperitoneal abscess secondary to previously placed infected mesh.
At this time, the patient was endotracheally intubated, excision again extended laterally to give us greater exposure. A limited lysis of adhesions was performed to separate the omentum off the abscess cavity and previously placed mesh. Once this was done, the mesh along with the abscess cavity was excised from the anterior abdominal wall using electrocautery. This was then passed off the table for pathological evaluation. Specimens of the abscess cavity were sent for culture and sensitivity, as well as a portion of the mesh was sent for culture and sensitivity.
Once this was done, the abdomen was copiously irrigated and hemostasis ensured. Once we ensured adequate hemostasis, the abdominal cavity was closed primarily using #1 Vicryl simple interrupted sutures in a figure-of-eight fashion. The dermis was then loosely approximated using #1 nylon in a simple interrupted vertical mattress-type suture. The patient was found to be stable. He was extubated and taken to the postanesthesia recovery area, where he was subsequently admitted for further observation, evaluation, and care. All sponge and instrument counts were correct at the end of procedure.
