Patuxent Medical Group, Inc.

Name: Hinman, David A

DOB: 2/14/70

Rec#: 103538-CR

Age: 28 Sex: M

Date: 2/24/98

DR: Jerrilyn M. Jutton, M.D.

Department of Surgery Consultation Note

Columbia Regional Medical Center

Mr. Hinman is a 28-year-old-male, who resides in Oregon. He was working out at the gym when he felt a burning pain, and subsequently has a left inguinal hernia. This has been terribly painful, but never incarcerated. The bulge is easily reducible. The patient denies any difficulty in moving his bowels. He has noted some increased pain with urination.

PHYSICAL EXAMINATION: On physical examination, height is 5’ 8", weight is approximately 165 pounds. He had an obvious bulge in the left groin area, which increases with the Valsalva maneuver. The right side is without any evidence of inguinal hernia or adenopathy. The area is somewhat tender, but again redues easily. The testicle was down bilaterally. He is a circumsised male. No adenopathy was appreciated on the left side either. Abdomen was otherwise benign.

IMPRESSION: Left inguinal hernia.

DISCUSSION: A discussion was held with the patient regarding repair. Patient education materials were given and diagrams were drawn. Left inguinal hernia repair and intravenous sedation and local anesthetic was discussed with the patient. The risks and complications include, but are not limited to, infection, bleeding, swelling of the scrotum, numbness, recurrent herniation. All of the patient’s questions were answered. The expected post operative course was also reviewed. A history and physical examination were performed, and the patient was scheduled for surgery in two days time.

Jerrilyn M. Jutton, M.D.

JMJ/cag D: 2/24/98 T: 3/03/98


ST. AGNES SURGERY CENTER

2850 North Ridge Road

Ellicott City, Maryland 21043

 

SSN#: 214-64-9955

 

DATE: 02/26/98

 

ACCT#: 022698-023A


PREOPERATIVE DIAGNOSIS: > Left inguinal hernia

POSTOPERATIVE DIAGNOSIS: > Left inguinal hernia

SURGEON: > Dr. Jerrilyn Jutton

ASSISTANT: > Dr. E. Fraiji

ANESTHESIA: > IV sedation, and local consisting of 1% Xylocaine with epinephrine, and 0.25% Marcaine.

PROCEDURE: > Left inguinal hernia repair with mesh plug

INDICATION: > The patient is a 28-year old male, with a moderately large, reducible left inguinal hernia. Risks and benefits of surgery, including the possibililty of numbness, incareration, infection, and bleeding were all discussed with the patient, who understood and agreed to proceed.

PROCEDURE IN DETAIL: The patient was taken to the operating room and placed supine on the operating room table. IV sedation was achieved. The left groin region was prepped and draped in sterile fashion. Local anesthetic was injected, and a skin incision was made, extending from the left pubic tubercle, out laterally towards the anterior-superior iliac spine. Dissection was deepened down through generous subcutaneous tissue, through Scarpa’s fascia, to the external oblique aponeurosis. This was opened in line with its fibers. The ilioinguinal nerve was rather small, and was noted to be cut. A very large direct hernia was noted. Dissection bluntly isolated the inguinal canal contents. Cremasteric muscle fibers were divided.

Looking around the internal ring and dividing the cremasteric muscle fibers, a small lipoma of the cord was identified and ligated. No indirect hernia sac was identified. The spermatic cord was notable normal. No very large veins. No varicocele was identified.

Using a medium size mesh plug, this was placed in the direct hernia area and tacked in place with 2-0 Prolene. The mesh patch was then placed on top of this, which was then sewn in place with a running suture of 2-0 Prolene, tacking it to the conjoint tendon superiorly and the shelving edge inferiorly. The wound was then irrigated profusely with normal saline. The canal contents were replaced back into the area. The external oblique aponeurosis was closed with a running suture of 2-0 Vicryl. The Scarpa’s fascia was closed with a running suture of 3-0 Vicryl. Several deep dermal sutures were placed, and the skin was closed with staples. A sterile dressing was applied. The patient was then awakened, and taken to the recovery room in stable and satisfactory condition. The left testicle was palpated in the scrotum at the end of the procedure.

 Jerrilyn Jutton M.D.

JJ/M7

DD: 2/26/98

DT: 3/2/98


PROGRESS NOTES:

3/3/98 LIH repair and mesh, Patient off all pain meds, moving slowly but denies pain, "just sore," Moved bowels, incision area healing well, staples out, s&d swollen area minimal soll into scrotum, good pap, advised 4-6 weeks out of work & lifting 40-60 pounds at work, pt aware

Jerrilyn Jutton