open inguinal herniorrhaphy - KC

The patient was met in the preoperative holding area, patient, consent, site and procedure to be performed confirmed. All questions answered. The patient was transported to the operating room and placed on the table in supine position. General anesthesia was induced and patient was intubated without issue. The patient was secured to the table with straps and all boney areas padded. The left inguinal area was prepped and draped in normal sterile fashion with Ioban. A timeout was done and all were in agreement. Incision was made over the medial aspect just above the inguinal ligament ligament. Incision was carried down through Scarpa's fascia external bleak was identified. This was opened along its fibers sharply with Metzenbaum along the length of the inguinal canal. The ilioinguinal nerve was identified and protected the cord was gently dissected away from the external oblique fascia and it was encircled with a Penrose drain. No direct hernia was noted. The cord was opened at the level of the cremasterics along their direction. The vas deferens and pampiniform plexus were identified and protected. A large indirect hernia was noted without any contents in the sac. This was gently and meticulously freed from the cord. It was simply reduced into the internal ring and the internal ring was closed slightly with interrupted 2-0 Vicryl in order to prevent the sac from coming back out. Polypropylene mesh was fashioned and was secured to the periosteum of the pubic tubercle with a single interrupted 0 PDS stitch. It was then secured to the conjoined tendon and internal oblique on the superior aspect of the floor and then to the shelving edge of the inguinal ligament on the inferior aspect all with interrupted 0 PDS. The internal ring was recreated with the tails of the mesh secured with 0 PDS on either side of the ring. It was not too tight. Hemostasis was achieved with electrocautery. External oblique was closed with running 2-0 Vicryl. Local field block was done with 1% lidocaine without epi. Scarpa's fascia was closed with interrupted Vicryl. Deep dermal was closed with interrupted Vicryl. It was closed with 4-0 Vicryl. The wound was dressed with Dermabond. The patient was awakened from anesthesia next day without issue and transported to PACU in stable condition.