The report below describes a patient undergoing a right inguinal hernia operation. The entire procedure has been documented in detail, describing the step by step process used by doctors to carry out the surgery. Keep reading for more on how this procedure was performed.nnDo you have a complicated surgery case that needs help with coding? Welter Healthcare Partners would love to help! Please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. nn– Click Here to Submit Redacted Surgery Case Study –nnPATIENT NAME: D., M.nnMR#: XXXXXnnSURGEON: T. G., M.D.nnDATE: 09/XX/2020nnPREOPERATIVE DIAGNOSES: Right inguinal hernia (direct), obesity.nnPOSTOPERATIVE DIAGNOSES: Right inguinal hernia (direct), obesity.nnOPERATIONS: Right inguinal hernia repair with mesh, excision of round ligamentnnSURGICAL ASSISTANT: J. D., SA-C.nnANESTHESIA: General endotracheal.nnESTIMATED BLOOD LOSS: Minimal.nnSPECIMEN REMOVED: Round ligament.n
INDICATION FOR SURGERY:
nThis is a 65-year-old female with a history of obesity, who has pain and bulge in the right groin consistent with inguinal hernia. The need for surgery and all the possible risks and complications were discussed at length with the patient with the help of the daughter, who helped with the translation. the patient understood, all the questions were answered, and she wanted to proceed with surgery.n
DESCRIPTION OF PROCEDURE:
nThe patient was brought in the operating room and placed on the table in supine position. After the general anesthesia was administered, the right groin and abdomen were prepped and draped in the usual sterile fashion.nnA slightly oblique incision was done in the right groin and deepened through the subcutaneous tissue. In the lower part of the inguinal area, the bulge of the inguinal hernia was identified. 11ie skin flaps were dissected. Good exposure of the fascia of external oblique muscle was obtained. 111e fascia was opened, and the inguinal canal was entered. 11ie patient had a quite very large bulging of the posterior wall of the inguinal cru1al consistent with a direct hernia. The round ligament was carefully divided between ligatures ru1d excised. A purse-string was placed in the fascia of the transversalis around the neck of the hernia and the bulging direct hernia was invaginated and the purse-string was tied. This repair was done with a O silk. At this point, the posterior wall of the inguinal canal was reinforced with a 2 x 4 Marlex mesh. The mesh was secured in place with 2 rows of continuous running 0 Prolene, suturing 1 margin of the mesh to the inguinal canal and the other margin of the mesh to the conjoint tendon and lateral margin of the rectus abdominis muscle fascia. 11ie fascia of the external oblique muscle was closed on top of the mesh with continuous running 0 Vicryl. The wound was irrigated with antibiotic solution. Perfect hemostasis was noted. Local anesthesia was injected. The wound was closed with continuous running 2-0 Vicryl in 2 layers for the subcutaneous tissue and continuous running 4-0 Monocryl subcuticular closure for the skin. Steri-Strips and sterile dressing were applied. The patient tolerated the procedure well and left the operating room in stable condition.