Preoperative Diagnosis: Right initial inguinal hernia and umbilical hernia Postoperative Diagnosis: Same Procedure: This 78-year-old patient was taken to Surgery, where he was prepped and draped in the normal sterile fashion. Incision was made from 2 cm above the pubic tubercle toward the anterior iliac spine and deepened to the external oblique. The external oblique was opened. The patient’s

cord was elevated on a Penrose drain. He had a very large direct inguinal hernia, no indirect hernia. All of the areas were freed up, and a piece of mesh was designed in a keyhole fashion and sutured in place with 2-0 Prolene, avoiding the nerve. Irrigation was performed. The external oblique was closed with 2-0 running chromic. Irrigation was performed again. Scarpa’s fascia was reapproximated using 3-0 chromic, and the skin was closed with staples. The umbilical hernia was then dissected out after an incision was made beneath the umbilicus. The hernia sac was removed. The fascia was closed with figure-of-eight sutures of 0 Prolene. 2-0 chromic was used to tack down the skin and also reapproximate the subcutaneous area. A running subcuticular of 4-0 Vicryl was placed and Benzoin and Steri-Strips were applied. A dry sterile dressing was applied to each. Betadine was applied to the hernia. The patient was returned to the recovery room in stable condition.

a. 49505–RT, 49585
b. 49520–RT, 49585
c. 49505–RT, 49585, 49568
d. 49507–RT, 49585, 49568

a. 49505–RT, 49585