The patient was brought to the operating room and placed in the supine position. General anesthesia was initiated without incident. Preoperative antibiotics were administered. The umbilicus was prepped and draped in standard sterile fashion. 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 agreed.
A 6cm curvilinear supraumbilical incision was made using a #15 blade and carried down into the subcutaneous tissues using electrocautery and assuring hemostasis along the way. Defect in the fascia was noted deep to our incision. A hernia sac was identified more caudal to the initial fascial defect with a second defect in the fascia seen. We dissected circumferentially around the hernia sac away from the fascia using a mix of electrocautery and blunt finger dissection. The sac was ligated and handed off for specimen.
The defect was estimated at _ cm in length. A _ mesh was placed at the _ level.
The fascia was closed with _. The umbilicus was reapproximated to the underlying fascia using a 3-0 Vicryl sutures.
The surgical site was instilled with 15ml of a 1:1 mixture of 0.5% Marcaine and 1% lidocaine with epinephrine. The remainder of the incision was closed in
layers using 3-0 Vicryl interrupted sutures in the deep dermal layer. We then place a 4-0 Monocryl running subcuticular suture. The incision was covered with Dermabond. A sterile dressing with a cotton ball in the umbilicus was placed after the Dermabond had dried.
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 all correct. The attending was present and active for the entirety of the procedure.
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Author: Garrett Skinner