Re-exploration of groin w/explantation of mesh...


Deltona, FL
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Hi, All. Hoping for some input.
Our surgeon did an open inguinal hernia repair on a patient. He had a severe amount of post-operative pain. So 3 days later, the same surgeon performed this surgery. I already coded the hernia repair. I'm a little confused about this one.

xcessive postoperative inguinal hernia pain, status post repair.

Re-exploration of right groin with explantation of mesh and ligation of the ilioinguinal nerve.

The patient was brought to the operating room and after attainment of sufficient general anesthesia, he was pretreated with antibiotics and prepped and draped in the usual sterile fashion. We scrub prepped him, opened the wound and just sort of split it with our fingers and got down to the external oblique fascia which we opened by taking out some of the stitches. Exposed the hernia repair, and actually the hernia repair was fine. The ilioinguinal nerve was identified. We had preserved it at the time of the surgery and it was loose in the incision, as is typical, but we elected just to ligate this nerve as we felt this might have been what was causing the problem. Once we did that, we then explanted the mesh. There were some Protacs placed. We unscrewed those, there were about five of those, and then took down the 2-0 Ethibond. All that was intact. Pulled out the plug, took out the permanent sutures from the plug, and then once that was done we irrigated the wound and the carried out a primary Bassini type repair. He had a really well-defined transverse abdominis aponeurosis and we brought it into opposition with the shelving edge of Poupart ligament. I took cultures on this patient before we had irrigated and my concern was I did not want to do a repair under stress and I also did not want to use biologics. So what I did was I went ahead and I just carried out an old fashioned Bassini type repair, if you will, the tried and true standard from the 1980's to bring this down and make sure that I had eliminated any chance that there was anything that was going to continue to bring on the same problem which was so debilitating for the patient preoperatively. Once I had done that, I irrigated the wound. The cord looked fine. We then closed the external oblique fascia with a running locking suture of 3-0 Vicryl, but not before placing a pain pump in below the fascia. There was on On-Q pain pump. We then closed deep tissues. We irrigated again. Closed the deep tissue with 3-0 Vicryl, then closed the skin with a running subcuticular suture of 4-0 Vicryl. A sterile dressing was applied. The patient tolerated the procedure well.

Thanks again for taking time out of your day to read this.


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What did you end up using here? I am also looking for a code for ligation of the ilioinguinal nerve & am not coming up with anything.