Operation: Left initial inguinal hernia repair with mesh

Procedure: The patient is a 28-year-old male who presented with several weeks’ history of pain in the left groin associated with a bulge. Examination revealed that the left groin did indeed have a bulge and the right groin was normal.

General anesthesia was induced. The left groin was sterilely prepped and draped and an inguinal incision made. This was carried down through the subcutaneous tissues until the external oblique fascia was reached. This was split in a direction parallel with its fibers, and the medial aspect of the opening included the external ring.

The cord structures were encircled and the cremasteric muscle fiber divided. At this point, the floor of the inguinal canal was examined and the patient did appear to have a weakness here.

A piece of 3 × 5 mesh was obtained and trimmed to fit. It was placed down in the inguinal canal and tacked to the pubic tubercle. It was then run inferiorly along the pelvic shelving edge until lateral to the internal ring and tacked down superiorly using interrupted sutures of 0-Prolene.

A single stitch was placed lateral to the cord to recreate the internal ring. The mesh was tucked underneath the external oblique fascia. The cord and nerve were allowed to drop back into the wound, and the wound was infiltrated with 30 cc. of half percent Marcaine. The external oblique fascia was then closed with a running suture of 0 Vicryl.

Subcutaneous tissues were approximated with interrupted sutures of 3-0 Vicryl. The skin was closed with a running subcuticular suture of 4-0 Vicryl. Benzoin and Steri-Strips and a dry sterile dressing were applied. All sponge, needle, and instrument counts were correct at the end of the procedure. The patient tolerated the procedure well and was taken to the recovery room in stable condition.

Case Study 8

0YU60JZ Supplement, Inguinal Region, Left (0YU6)

Rationale: The left inguinal hernia is approached via an incision. For the repair to be a stable and reinforced, mesh is inserted into the inguinal canal to supplement the hernia repair.

Reminder: When mesh is used for hernia repairs, the root operation is supplement.

We also want to start in the index: Herniorrhaphy > With Synthetic Substitute > See Supplement.