ggparker14
True Blue
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Looking at 49520 and 11008 ( but no infection noted for 11008?)
procedures:
1. left inguinal exploration with mesh removal and primary sutured inguinal hernia repair. Note the hernia was reducible.
2. Left inguinal nerve block.
op note reads: the old incision was excised through the full thickness of the skin and through the underlying tissue. Layers of fascial scar tissue were then carefully sharply excised down to the palpable foreign body which was then meshed within the surrounding muscular tissues. The portions of the mesh attached to the pubic tubercle and medially to the remaining inguinal ligament and internal oblique fascia laterally were carefully excised with a combination of blunt and cautery dissection. This revealed curling and bunching beneath the transversalis fascia of the deep portion of the mesh which corresponded with the patient's palpable abnormality. The tissues in this region overlying the femoral artery beneathtransversalis fascia were carefully dissected with hemostasis and suture ligated with 3-0 silk sutures. This included ligation of several small arterial and venous branches. The entire mesh was examined and found to be hemostatic. The femoral artery was palpated and found to be intact with a strong pulse. The remaining bits of fascia attached to the left lateral rectus muscle were then sutured to the tissues at the pubic tubercle transitioning to gthe internal oblique fascia. A suture repair of the direct inguinal hernia was accomplished with multiple interrupted sutures of 0 Prolene. Wound cavity was again irrigated with warm saline and examined for hemostasis. The remaining layers of the scar tissue and fascia were closed in two layers of 2-0 and 3-0 Vicryl. The deep dermis was then closed with 3-0 Vicryl followed by a running subcuticular suture of 4-0 Monocryl.
procedures:
1. left inguinal exploration with mesh removal and primary sutured inguinal hernia repair. Note the hernia was reducible.
2. Left inguinal nerve block.
op note reads: the old incision was excised through the full thickness of the skin and through the underlying tissue. Layers of fascial scar tissue were then carefully sharply excised down to the palpable foreign body which was then meshed within the surrounding muscular tissues. The portions of the mesh attached to the pubic tubercle and medially to the remaining inguinal ligament and internal oblique fascia laterally were carefully excised with a combination of blunt and cautery dissection. This revealed curling and bunching beneath the transversalis fascia of the deep portion of the mesh which corresponded with the patient's palpable abnormality. The tissues in this region overlying the femoral artery beneathtransversalis fascia were carefully dissected with hemostasis and suture ligated with 3-0 silk sutures. This included ligation of several small arterial and venous branches. The entire mesh was examined and found to be hemostatic. The femoral artery was palpated and found to be intact with a strong pulse. The remaining bits of fascia attached to the left lateral rectus muscle were then sutured to the tissues at the pubic tubercle transitioning to gthe internal oblique fascia. A suture repair of the direct inguinal hernia was accomplished with multiple interrupted sutures of 0 Prolene. Wound cavity was again irrigated with warm saline and examined for hemostasis. The remaining layers of the scar tissue and fascia were closed in two layers of 2-0 and 3-0 Vicryl. The deep dermis was then closed with 3-0 Vicryl followed by a running subcuticular suture of 4-0 Monocryl.