The scalpel was used to make an infraumbilical incision. This was carried down through subcutaneous tissue to the fascia, and the fascia was entered. Once this was done, a 5 mm port was placed using Hasson technique. Pneumoperitoneum was obtained, and the camera was introduced into the abdominal cavity. A second 5 mm port was then placed in the right lower quadrant, as well as a 10 mm port was placed in the left lower quadrant. Once this was done, the patient had some adhesions of his cecum up to the abdominal wall. This was taken down sharply with Metzenbaum scissors. Once this was done, the bowels were easily freed from the abdominal wall. The Metzenbaum scissors with Bovie cautery were then used to make an incision into the peritoneum, and a peritoneal flap was then created. The cord structures were dissected free from the surrounding peritoneum. The epigastric vessels were detected up against the abdominal wall. This was carried on down to the inguinal vein and artery were identified, as well as the hernia was then identified. There was a large amount of fat that was pulled back to the abdominal cavity.
Once this was done, he still had a large amount of fat that was incarcerated into the hernia sac that was not able to be reduced laparoscopically. The scalpel was then used to make a counter incision in his right groin over the incarcerated fat. Once this was done, the incarcerated adipose tissue was then identified, and dissected free of the surrounding tissues and transected.
Once this was done, the patient had an obvious tract from his abdominal cavity into this femoral hernia. The defect was then closed through this counter incision with 0 Vicryl stitches. Once this space was obliterated, the skin was then reapproximated in two layers, first with interrupted 3-0 Vicryl, then with a running 4-0 Monocryl subcuticular stitch
am I looking at 49553 or is it still lap any opinions who help'