inguinal hernia repair

Open repair of an indirect inguinal hernia is performed to restore strength to the inguinal floor and prevent the abdominal viscera from entering the inguinal canal. This is a 53-year-old male. The patient has a history of multiple abdominal surgeries and opted for an open left inguinal hernial repair with Prolene mesh. The circulator brought the patient to the operative suite in a stretcher. The patient move from the stretcher to the OR table with some assistance. He then laid in the supine position with the safety straps around his abdomen. Anesthesia started IV sedation with local.

The circulator and scrub tech started their first count. They counted 5 laps, 10 CDs, 1 CT, 2 blades, 1 injectable and 6 needles. The circulator started the prep with cloraprep. The surgeon came in and started to drape the patient with 4 towels with adhesive and a transverse sheet. A ‘time out’ is called by the circulator to indentify the patient. First, the skin was anesthetized with 1% lidocaine and then a transverse incision was made with a #15 blade scalpel. Dissection was then carried down with electro cautery through fascia controlling the bleeders.

Once the external oblique was identified, external oblique was incised in the length of its fibers with a #15 blade scalpel. Metzenbaum scissors were then used to extend the incision in both directions opening up the external oblique down to the external ring. Next, the external oblique was grasped with Kocher on both sides. The cord structures as well as hernia sac were freed up and a Penrose drain was placed around it. Next, the hernia sac was identified and the anteromedial portion of the hernia sac was stripped down, grasped with two hemostats. A Metzenbaum scissor was then used to open the hernia sac and the hernia sac was explored.

There was some turbid fluid within the hernia sac, which was sent down for cultures. Next, the hernia sac was to be ligated at its base. Metzenbaum scissor was used to cut the hernia sac and the circulator sent it off as a specimen. A #0 Vicryl stick suture was used with #0 Vicryl loop suture to suture legate the hernia sac at its base. Next, attention was made to placing a Prolene mesh to cover the floor. The mesh was sutured to the pubic tubercle medially along the ilioinguinal ligament inferiorly and along the conjoint tendon superiorly making a slit for the cord and cord structures.

Attention was made to salvaging the ilioinguinal nerve, which was left above the repair of the mesh and below the external oblique once closed and appeared to be intact. Attention was next made after suturing the mesh with the #2-0 Polydek suture. At this point the scrub and circulator are during the count. They counted 5 laps, 10 CDs, 1 CT, 2 blades, 1 injectable, and 6 needles, their count was good. The surgeon moved on with the external oblique closed over the roof with a running #0 Vicryl suture, taking care not to strangulate the cord and to recreate the external ring.

After injecting the external oblique and cord structures with Marcaine for anesthetic, the fascia was approximated with interrupted #3-0 Vicryl sutures. The skin was closed with a running subcuticular #4-0 undyed Vicryl suture. Steri-Strip with sterile dressings was applied. The anesthesia started to extubate the patient. When the anesthesia was comfortable with the stability of the patient vital signs the anesthesia and the help from the scrub and circulator moved the patient from the OR table to the stretcher. The circulator then took the patient to post-op care for recovery.

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