Case study 4.

Operative note

The 45 year old male patient was taken to the operative suite, placed on the table in the supine position and given a spinal right inguinal region was shaved, prepped and draped in routine sterile fashion. The patient received 1 gum of ancef iv push. A transverse incision was made into the intra-abdominal crease and carried through the skin and subcutaneous tissue. The external oblique fascia was exposed and incised down to, and through, the external inguinal ring. The spermatic cord and hernia sac were dissected bluntly off the undersurface of the external oblique fascia exposing the attenuated floor of the inguinal canal. The cord was surrounded with a pen rose drain. The sac was separated form the cord structures.
The floor of the inguinal canal, which consisted of attenuated transversal is fascia, was imbricated upon itself with a running lock suture of 2-0 proline. Marlex path, 1 x 4 in dimension, was trimmed to an appropriate shape with a defect to accommodate the cord. It was placed around the cord and suture to itself the 2-0 Prolene. The patch was then surged medically to the pubic tubercle, inferiority to coopers ligament and inguinal ligaments, and superior to conjoined tendon using 2-0 vicryl. The area was irrigated with saline solution and 0.5% marcaine with epinephrine was infected to proved prolonged postoperative pain relief. The cord was returned to its position. External oblique fascia was closed with a running 2-0 PDS subcuticular with 2-0 vicryl and skin with running subdermal 4-0 vicryl and sterile-strips. Sponge and needle counts were correct. Sterile dressing was applied.

A.49505
B. 49505, 54520
C. 49505, 49568
D. 49505, 54520, 49568