Lap Bilateral Hernia
Preop Diagnosis - bilateral inguinal hernias
Postop Diagnosis - same
Surgeon - Dr. Luk / Dr. Tran
Assistant Surgeon -
Anesthesia - General Anesthesia
Blood Loss - Minimal
Complication - None
Findings - bilateral inguinal hernias
Specimens - none
Procedure Performed-
Laparoscopic Repair of Bilateral Inguinal Hernias
Patient comes in with the above diagnosis and was consented for the above procedures. Risks, benefits, and alternatives were discussed with patient, which includes, but are not limited to, postoperative or chronic pain, bleeding, wound infection, hematoma, post-operative abscess, or need for further procedures or workup. Other Complications may include deep vein thrombosis (blood clots), as well as other side effects affecting other organ systems such as the heart or lungs, and in rare circumstances, death as a result of the above complications. The patient understands and agrees to proceed with the proposed procedure. During our discussion, the patient is aware and agreed that mesh will be used for the repair. The site was marked with the patient.
The patient was given preoperative antibiotics.
DESCRIPTION OF OPERATIVE PROCEDURE: The patient was seen in the preoperative holding area. The correct site was marked with the patient's cooperation. The patient was given preoperative antibiotics and he was then brought back to the operating room and placed supine on the OR table. A Foley catheter was placed. The patient underwent general anesthesia without problems. The patient was then prepped and draped using standard prep. A time-out was performed to confirm the patient and the case to be done.
Once, all were in agreement, a number 11 scalpel was used to make a small 1-cm incision in the infra-umbilical location. Dissection down to the anterior abdominal fascia was performed using the retractors. The anterior fascia was opened meticulously using a number 11 scalpel. This was done carefully to avoid puncturing the posterior fascia. Next the rectus muscle was mobilized in a lateral direction using the retractor. When the posterior fascia was clearly identified then blunt dissection was used to enlarge the preperitoneal space. Finally, to further create the space, the space maker balloon was placed in to the space and it was insufflated manually and also under direct vision to enlarge the preperitoneal space. When this was accomplished then the working trocar was placed into the preperitoneal space. Carbon dioxide was then used to insufflate the space so that it could be maintained. Next, two additional 5-mm ports were placed. These were placed in the low midline under direct vision to avoid any inadvertent injury to the bowel. Next the atraumatic grasper was used to perform dissection.
Before the procedure began identification of the landmarks was carried out. This included the pubic tubercle, the epigastric vessel, and femoral vessels. Since the patient had bilateral inguinal hernias, both sides were performed in similar fashion.
Dissection is carried out first in a lateral direction, lateral to the epigastric vessels to identify the pelvic sidewall. Once this was accomplished then dissection was carried out medially to separate the spermatic cord or round-ligament from the surrounding adherent tissue/hernia sac. Any contents of the hernia was reduced back into the preperitoneal space.
The patient had a direct hernia.
The patient had an indirect hernia. Hernia sac is tied off with endoloop completing a high ligation.
For repair, a hernia mesh was placed into the preperitoneal space after soaked in antibiotics solution. The mesh was carefully placed so that it covered the entire defect with plenty of overlapping circumferentially. Once this was accomplished then it was tacked carefully into position using a total of 1 tacks on the pubic tubercle. One tack was used to secure the mesh laterally. Finally when the repair was completed I evaluated the preperitoneal space in its entirety to be sure there was no bleeding. There was none. There were no injury to other organ identified, cord/vessels well preserved during the process.
Once hemostasis was completely assured then the trocars were removed first. The carbon dioxide gas was released from the preperitoneal space. Finally the working trocars were removed. The anterior fascia was then reapproximated using 0 Vicryl suture. Local anesthesia comprised of a mixture of Marcaine and lidocaine was used to infiltrate the incisions to help the patient with postoperative pain.
At the end of the case, counts were carried out. The instrument, sponge, and needle
counts were completed and reported to me as correct.
All incisions were then closed using 4-0 Monocryl stitch.
At the end of the case the Foley catheter was removed.
The patient overall tolerated the procedure well, no complications, extubated, and was transferred to the recovery room in stable and satisfactory condition.