I have been doing general for only a little while, and I really need some guidance on multiple hernia repairs done during the same operative session. It seems like there is a lot of conflicting info out there, so please help!

Here's an op report I'm not sure what to do with:

A midline incision was again made going through the previous surgical scar at the mid abdomen level just above and below the umbilical area. There was a large hernia defect, more than 10 cm, hernia sac contained omentum and multiple loops of the small bowel. They were adherent to the hernia sac. These loops were taken down separating from the hernia sac. Omentusm was also freed and the hernia sac was excised. Subcutaneous tissue flaps were developed on both sides because of extensive separation of the muscles in the midline and a second hernia defect at the colostomy site and the left lower quadrant approximately 4 to 5 cm size.

Midline incision has been extended downwards to facilitate exposure of the second hernia defect in the left lower quadrant. Peritoneal sac was excised. Subcutaneous tissue flaps had been developed up to the lateral abdominal margins. So, the defect could be clearly visualized and peritoneal sac was excised from the left lower quadrant. This defect was then approximated with interrupted #1 Ethibond mattress type sutures in a transverse fashion. Two additional sutures of second layer closure was also utilized, and then 19/27 cm Bard Composix patch was selected for a placement in the preperitoneal space.

Let me know what you think! Thanks :0)