General Surgery

INCISION:Longitudinal incision over herniation in midlineFINDINGS:ParaUmbilical hernia 1cm defect with pre-peritoneal fat herniation.Contained only pre-peritoneal fat appearing healthy, no bowel involvement.PROCEDURE:Herniations cleared all round.Excess herniated fat suture transfixed.Ensured adequate clearance of fascia all around.CLOSURE:No 1 Ethilon interrupted fascial sutures closing hernial defect.Subcutaneous tissue approximated with 2.0 Vicryl.3.0 Monocryl Subcuticular sutures to skin.Dressings applied

INCISION:Longitudinal incision over herniation in midlineFINDINGS:Paraumbilical hernia approx. 3cm defect with pre-peritoneal fat herniation.Contained only pre-peritoneal fat appearing healthy, no bowel involvement.PROCEDURE:Herniations cleared all round.Reduction of herniated fat.Ensured adequate clearance of fascia all around.CLOSURE:Ventra Patch Mesh (Parietex) applied – securedNo 1 Ethilon interrupted fascial sutures closing hernial defect.Subcutaneous tissue approximated with 2.0 Vicryl.3.0 Monocryl Subcuticular

INCISION:Elliptical incision excising unhealthy tissue overlying abscess FINDINGS:Ischiorectal Abscess … O’Clock measuring … x … cm PROCEDURE:Examination under Anaesthesia Rectum – no internal opening identifiedPus sent for C&SDe-roofing of abscess cavity with removal of unhealthy skinPus evacuated – CurettageHemostasisWash with salinePacked with SorBact CLOSURE:Dressings applied

INCISION:Ellipitical incision Pilonidal area including sinusesFINDINGS:Large abscess cavity with about 50 ml pusPROCEDURE:Pus for c&SLoculations disrupted using gloved fingerSlough evacuated – CurettageHemostasisWash with saline & betadinePacked with SorBactCLOSURE:Dressings applied Pressure dressingPOST OPERATIVE INSTRUCTIONS:Observations Q4HHome later today all being wellDiet: Eat and Drink as toleratedPressure dressing to stay for 24-48 hoursAlternate day dressings; starting day after

INCISION:Transverse incision over most fluctuant areaFINDINGS:Large Sebaceous abscess 10 x 10 cmPROCEDURE:Pus evacuated – CurettageHemostasisWash with salinePacked with SorBactCLOSURE:Dressings appliedPressure dressing

INCISION: Medial 2/3 of line joining ASIS and Pubic Tubercle FINDINGS: Large indirect inguinoscrotal hernia containing bowelPROCEDURE: Dissected down to and through External Oblique AponeurosisHernial sac identifiedHerniation reducedSac suture transfixedDeep ring tightenedSoft mesh 10x15cm cut to sizeSecured with Tacs and suturesNew superficial ring createdHemostasis ensuredCLOSURE: Subcutaneous 2.0 vicryl suturesClips to skinPOST OPERATIVE INSTRUCTIONS:Observations Q4HDiet: Eat and

INCISION: EllipticalFINDINGS: Moderately large sebaceous cystPROCEDURE: Cyst excisedHemostasis ensuredSaline washCLOSURE: 3.0 Monocryl interrupted simple suturesOpsite sprayP/O OPERATIVE INSTRUCTIONSHome later today all being wellTo keep area dry

INCISION: Cruciate incision over most fluctuant areaFINDINGS: Left/Right groin abscess … x … cmPROCEDURE:Femoral artery palpated; confirmed abscess well away from itPus sent for C&SDeroofing of abscess cavity with removal of unhealthy skinPus evacuated – CurettageHemostasisWash with salinePacked with SorBact/SorbsanCLOSURE:Dressings applied

INCISION:Longitudinal incision over herniation in midline.FINDINGS: Epigastric hernia …cm defect with pre-peritoneal fat herniation.Contained only pre-peritoneal fat appearing healthy, no bowel involvement.PROCEDURE: Herniations cleared all round.Reduction of herniated fat.Ensured adequate clearance of fascia all around.CLOSURE:No 1 Ethilon interrupted fascial sutures closing hernial defect.Subcutaneous tissue approximated with 2.0 Vicryl.3.0 Monocryl Subcuticular sutures to skin.Dressings applied.

PRE-OPERATIVE Operation: Indication:Date: CEPOD: Surgeon:Assistant:Anaesthetist: Anaesthetic: ASA Grade: WHO Checklist: Antibiotics: Urinary Catheter:Patient Position: INTRA-OP Ports:Findings:Procedure:Closure: POST OPERATIVE INSTRUCTIONS: Observations Q4HPost op bloods tomorrow (ddmmyy)Diet: Eat and Drink as toleratedLMWH at 18:00 hours