cpccoder2008
True Blue
PREOPERATIVE DIAGNOSIS
ossible recurrent right inguinal hernia.
POSTOPERATIVE DIAGNOSIS:No recurrence found.
OPERATIONS:Re-expression of right inguinal hernia.
OPERATIVE FINDINGS: Induration of cord, Doppler confirmation of blood flow to the right testicle, confirmation of the vas deferens.
SPECIMENS: None.
ANESTHESIA: General endotracheal anesthesia plus local Marcaine.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: 20 mL.
FLUIDS: 1900 mL.
COMMENTS: To recovery room in satisfactory condition.
HISTORY OF PRESENT ILLNESS: This is a 49-year-old male status post right inguinal hernia repair on 09/10/2012 who had had a recurrence of bulge in his right groin and then in his scrotum with occasional episodes of nausea and vomiting. An ultrasound on 09/21/2012 showed recurrent hernia and bilateral hydrocele and the patient was consented for re-exploration of possible recurrent right inguinal hernia with repair.
OPERATION IN DETAIL: The patient was brought back to the operating room and in supine position general endotracheal intubation was achieved without any difficulty. The patient was prepped and draped in sterile fashion. Incision was made along the right inguinal scar after a time-out had been performed. Dissection was made down to the external oblique. There was a significant amount of scarring. The dissection with a Kitner was made around the cord. There were some superior stitches that were removed. There was a highly indurated cord. We were able to get around the cord and isolate it with a Penrose drain. Considerable dissection revealed a narrow neck and no hernia sac. Ultrasound was used intraoperatively in an attempt to identify vessels or any bowel. We were not able to delineate any of the structures; however, a Doppler was able to identify triphasic wave of pulse through the cord. The vas deferens was identified. At this time, it was determined that there was no recurrence, but there was extensive swelling of the scrotum and testicle. The wound was irrigated and was hemodynamically stable. We then attempted to reapproximate the external oblique with 3-0 Vicryl. The wound was then closed with a deep dermal interrupted Vicryl and a 4-0 Monocryl stitch. Local was injected around the wound for local pain control. The patient tolerated the procedure well.
ossible recurrent right inguinal hernia.POSTOPERATIVE DIAGNOSIS:No recurrence found.
OPERATIONS:Re-expression of right inguinal hernia.
OPERATIVE FINDINGS: Induration of cord, Doppler confirmation of blood flow to the right testicle, confirmation of the vas deferens.
SPECIMENS: None.
ANESTHESIA: General endotracheal anesthesia plus local Marcaine.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: 20 mL.
FLUIDS: 1900 mL.
COMMENTS: To recovery room in satisfactory condition.
HISTORY OF PRESENT ILLNESS: This is a 49-year-old male status post right inguinal hernia repair on 09/10/2012 who had had a recurrence of bulge in his right groin and then in his scrotum with occasional episodes of nausea and vomiting. An ultrasound on 09/21/2012 showed recurrent hernia and bilateral hydrocele and the patient was consented for re-exploration of possible recurrent right inguinal hernia with repair.
OPERATION IN DETAIL: The patient was brought back to the operating room and in supine position general endotracheal intubation was achieved without any difficulty. The patient was prepped and draped in sterile fashion. Incision was made along the right inguinal scar after a time-out had been performed. Dissection was made down to the external oblique. There was a significant amount of scarring. The dissection with a Kitner was made around the cord. There were some superior stitches that were removed. There was a highly indurated cord. We were able to get around the cord and isolate it with a Penrose drain. Considerable dissection revealed a narrow neck and no hernia sac. Ultrasound was used intraoperatively in an attempt to identify vessels or any bowel. We were not able to delineate any of the structures; however, a Doppler was able to identify triphasic wave of pulse through the cord. The vas deferens was identified. At this time, it was determined that there was no recurrence, but there was extensive swelling of the scrotum and testicle. The wound was irrigated and was hemodynamically stable. We then attempted to reapproximate the external oblique with 3-0 Vicryl. The wound was then closed with a deep dermal interrupted Vicryl and a 4-0 Monocryl stitch. Local was injected around the wound for local pain control. The patient tolerated the procedure well.