ksb0211
Guest
Just wondering what other thoughts were on this surgery. Would you consider the femoral as bundled into the inguinal repair? How would you code this out? Thanks.
PREOPERATIVE DIAGNOSIS
Right inguinal hernia.
POSTOPERATIVE
Right inguinal hernia, indirect and femoral type.
OPERATION PERFORMED
Laparoscopic right inguinal indirect and femoral hernia repair.
DESCRIPTION OF PROCEDURE
The patient was taken to the OR. After adequate general anesthesia the patient was prepped with DuraPrep and draped sterilely. Perioperative antibiotics had been administered. The initial incision was made in the infraumbilical region over a 15 blade. A 5 mm Optivu port was passed without difficulty. Circumferential view of the peritoneal cavity was unremarkable. A left inguinal hernia was appreciated. It appeared to be an indirect hernia. The 5 mm port was placed in the left and right rectus muscle and the umbilical site was exchanged for a 10-12 port. The patient was placed in severe Trendelenburg position. The peritoneum was incised over the anterior abdominal wall and the peritoneum lifted. Ultimately we crossed the region of the indirect hernia. The round ligament was noted to enter the inguinal canal. The hernia sac was reduced. The round ligament was divided. Dissection was continued. A small femoral hernia was identified concurrently. This was reduced as well. A Bard 3D Max medium left mesh was then applied. It was secured with the ProTack stapling device. The peritoneum was then tacked onto the anterior abdominal wall covering the mesh. No significant bleeding was encountered. The mesh appeared to be in appropriate position. The abdomen was deflated of CO2. The wounds were injected with 0.5% Marcaine. The fascia was closed with 0-Monocryl and 4-0 Vicryl subcuticular stitches, utilized Steri-Strips and Tegaderm were applied. The patient tolerated the procedure.
PREOPERATIVE DIAGNOSIS
Right inguinal hernia.
POSTOPERATIVE
Right inguinal hernia, indirect and femoral type.
OPERATION PERFORMED
Laparoscopic right inguinal indirect and femoral hernia repair.
DESCRIPTION OF PROCEDURE
The patient was taken to the OR. After adequate general anesthesia the patient was prepped with DuraPrep and draped sterilely. Perioperative antibiotics had been administered. The initial incision was made in the infraumbilical region over a 15 blade. A 5 mm Optivu port was passed without difficulty. Circumferential view of the peritoneal cavity was unremarkable. A left inguinal hernia was appreciated. It appeared to be an indirect hernia. The 5 mm port was placed in the left and right rectus muscle and the umbilical site was exchanged for a 10-12 port. The patient was placed in severe Trendelenburg position. The peritoneum was incised over the anterior abdominal wall and the peritoneum lifted. Ultimately we crossed the region of the indirect hernia. The round ligament was noted to enter the inguinal canal. The hernia sac was reduced. The round ligament was divided. Dissection was continued. A small femoral hernia was identified concurrently. This was reduced as well. A Bard 3D Max medium left mesh was then applied. It was secured with the ProTack stapling device. The peritoneum was then tacked onto the anterior abdominal wall covering the mesh. No significant bleeding was encountered. The mesh appeared to be in appropriate position. The abdomen was deflated of CO2. The wounds were injected with 0.5% Marcaine. The fascia was closed with 0-Monocryl and 4-0 Vicryl subcuticular stitches, utilized Steri-Strips and Tegaderm were applied. The patient tolerated the procedure.