Right open inguinal hernia - TF

The patient was brought to the operating room and placed in the supine position. General anesthesia was initiated without incident. The right groin was prepped and draped in standard sterile fashion. Preoperative antibiotics were administered. A timeout was performed by which the patient was identified using 2 patient identifiers, and the site and proposed procedure were confirmed. All team members were in agreement.

An 6cm oblique incision was made 1 finger's breadth above the inguinal ligament between the ASIS and pubic tubercle. Using electrocautery this was carried down to the external oblique aponeurosis as hemostasis was assured along the way. The external oblique aponeurosis was identified, cleared of overlying tissues, and incised with Metzenbaum scissors. The incision was carried medially to the external ring and laterally to reveal the underlying cord. The spermatic cord structures were bluntly dissected off of the posterior aspect of the external oblique aponeurosis using finger dissection.

The spermatic cord was then finger dissected off of the floor of the inguinal canal at the level of the pubic tubercle and encircled with a Penrose drain.

There was noted to be ***.

The Prolene 6.1 x 13.7cm keyhole mesh was secured to the pubic tubercle with 0 Prolene.

The inferior border was sutured to the shelving edge of inguinal ligament with a running 0 Vicryl suture. With care taken to ensure that the mesh sat flat on the floor of the inguinal canal, the superior border was sutured to the transversalis fascia with interrupted 0 Vicryl sutures. Care was taken not to entrap any nerves. The hernia defect was completely covered by the mesh overlapping onto normal healthy tissue and we were satisfied with the extent of our repair.

The internal ring was re-created by suturing the tails of the mesh together, with care taken to avoid impinging on the cord structures. A small finger was easily able to pass in the reconstructed ring. The surgical incision was then irrigated and hemostasis was assured. The cord was verified to be intact and in a neutral position. The mesh repair was tension free and flat.

The external oblique fascia was closed in a running fashion with 2-0 Vicryl. The remainder of the incision was closed in layers using 3-0 Vicryl running sutures in Scarpa's fascia and interrupted deep dermal layer. 10 cc local anesthetic was injected. Skin was then closed with a 4-0 Monocryl running subcuticular suture. The incision was covered with Dermabond. The testicles were palpated and were mobile and normal to inspection.

The patient was liberated from anesthesia and brought to the PACU in stable condition. The sponge, instrument and needle counts at the end procedure were correct x2. The attending present and active for the entirety of the procedure.