Hernia Repair Operative Note (Inguinal)

(This template is for immediate postoperative documentation. Do not infer laterality, approach, hernia type, mesh details, nerve management, or complications. Omit subsections that do not apply rather than leaving empty placeholders. Use explicit "None" where absence must be unambiguous.)

Procedure: Inguinal Hernia Repair — [Open / Laparoscopic TEP / Laparoscopic TAPP / Robotic TEP / Robotic TAPP]

Date of Surgery: [Date]

Start Time / End Time: [Start time] / [End time]

Surgeon: [Name, credentials]

Assistant(s): [Name(s), credentials] (Omit if none)

Facility/OR: [Facility name / OR number]

Approach: [Open / Laparoscopic TEP / Laparoscopic TAPP / Robotic TEP / Robotic TAPP] (If conversion occurred, document from→to and reason)

Laterality: [Left / Right / Bilateral]

Urgency: [Urgent / Emergent] (Omit if elective)

Preoperative Diagnosis

• [Side] [Suspected hernia type] (e.g., "Right inguinal hernia, suspected indirect")
• (Add line for each side if bilateral)

Postoperative Diagnosis

• [Side]: [Confirmed hernia type: direct / indirect / femoral / pantaloon / sliding] (If no hernia found on explored side, state explicitly: "No hernia identified; cord lipoma present" or "No hernia identified")
• (List each side separately for bilateral cases)

Procedure(s) Performed

• [Primary procedure with laterality and approach] (e.g., "Right inguinal hernia repair, open anterior approach, with mesh")
• [Add-on procedure] (Include only if performed: femoral hernia repair, diagnostic laparoscopy, adhesiolysis, mesh explantation, orchiectomy, bowel resection)

Indications

[Clinical indication: symptoms, relevant history, risk factors] (2–4 sentences. State that informed consent was obtained including discussion of risks: recurrence, chronic pain, infection, mesh-related complications, nerve/testicular/cord injury; for laparoscopic/robotic: visceral/vascular injury and potential conversion.)

Anesthesia and Prophylaxis

• Anesthesia: [General / Spinal / MAC / Local with sedation]
• Regional block: [Type and laterality] (Omit if none)
• Antibiotic prophylaxis: [Agent, dose, timing] (If not given, state reason)
• Positioning: [Position, arm placement, precautions]

Operative Findings

(Document findings for each explored side)

• Right: [Hernia type] | [Reducible / Incarcerated / Strangulated] | [Size: small / medium / large] | [Contents] | [Associated findings: cord lipoma, floor weakness, enlarged internal ring, prior mesh, adhesions] (Omit if right side not explored)
• Left: [Hernia type] | [Reducible / Incarcerated / Strangulated] | [Size: small / medium / large] | [Contents] | [Associated findings] (Omit if left side not explored)
• TAPP contralateral inspection: [Inspected / Not inspected]; [Findings] (Include only for TAPP)

Operative Technique

[Narrative description of procedure] (Include positioning, incision or port placement, entry technique, and sequence of operation. For bilateral cases, describe each side. Include approach-specific elements below.)

Open Repair

• Technique: [Lichtenstein / Shouldice / tissue repair / other]
• Exposure and cord mobilization: [Description]
• Hernia sac management: [Dissected / reduced; high ligation; distal sac handling]
• Cord lipoma: [Reduced / excised / not present]
• Nerve handling: [For each nerve—ilioinguinal, iliohypogastric, genital branch—state: visualized and preserved / not visualized / intentionally divided with rationale] (Do not state "identified and preserved" unless actually visualized)

TEP Repair

• Preperitoneal entry: [Balloon / blunt dissection]; [Peritoneal violations: none / repaired]
• Port configuration: [Sizes and positions]
• Landmarks identified: [Cooper's ligament, inferior epigastrics, cord structures]
• Sac reduction and parietalization: [Description]
• Femoral space: [Visualization and assessment]
• Desufflation: [Mesh position confirmed without folding/rolling]

TAPP Repair

• Abdominal entry and ports: [Technique and locations]
• Peritoneal flap: [Creation technique and boundaries]
• Sac dissection: [Direct/indirect components addressed]
• Femoral space: [Assessment]
• Peritoneal closure: [Method: suture / tack / glue]; [Confirmation of no gaps]

Robotic-Assisted Details

(Include only for robotic cases)

• System and docking: [Platform; docking position]
• Instruments: [Key instruments and energy devices]
• Console time: [Duration] (If tracked)

Conversion

(Include only if conversion occurred)

Conversion from [initial approach] to [final approach] due to [reason]. [Steps completed prior to conversion]. Final completed approach: [approach].

Mesh and Implant Details

(For bilateral repairs, document each side separately. If no mesh, state "No mesh implanted" and describe tissue repair technique.)

• Side: [Left / Right] — Product: [Manufacturer and product name] — Material: [Polypropylene / Polyester / Composite / Biologic] — Dimensions: [cm × cm] — Plane: [Anterior on floor / Preperitoneal] — Fixation: [None / Glue / Tacks / Suture] at [specific sites: Cooper's ligament, ASIS region, rectus sheath, lateral abdominal wall] — Identifiers: [Lot/Serial/UDI or "See implant log"]
• (Add line for contralateral side if bilateral)

Specimens, Drains, and Blood Loss

• Estimated Blood Loss: [mL / Minimal]
• Specimens: [Specimen type and destination: pathology / gross exam / discarded] or None
• Drains: [Type and location] (Omit if none)

Complications

[None / Description of complication(s)] (If complications occurred: describe what happened, inherent vs accidental, repair performed, and impact on postoperative care)

Counts

Sponge, needle, and instrument counts [correct ×2 / not performed due to (reason) with (mitigation)].

Closure

• Fascia: [Suture material and technique]
• Subcutaneous: [Closure method] (Omit if not closed)
• Skin: [Staples / sutures / adhesive / strips]
• Local anesthetic: [Agent, volume, sites] (Omit if none)
• Dressing: [Type applied]

Disposition and Postoperative Plan

• Condition: [Hemodynamically stable, extubated, etc.]
• Destination: [PACU / ICU]
• Plan: [Activity guidance, pain management, urinary retention precautions if applicable, wound care, follow-up timing]