Hernia Repair Operative Note (Ventral/Incisional)

Patient name: [Full name]

MRN or DOB: [Identifier per institutional policy]

Date of procedure: [MM/DD/YYYY]

Start time: [HH:MM] Stop time: [HH:MM]

Facility: [Facility name] OR/Procedure room: [Room number]

Urgency: [elective / urgent / emergent]

Primary surgeon: [Name, credentials]

Co-surgeon(s) and assistant(s): [Names and roles] (Only include if applicable)

Anesthesia type: [general / regional / MAC / local]

Preoperative Diagnosis

[Hernia type: ventral vs incisional; primary vs recurrent; laterality and location]

Postoperative Diagnosis

[Final hernia diagnosis based on intraoperative findings: incisional vs primary ventral; recurrent vs first repair; incarcerated or strangulated status with contents if applicable; additional findings such as multiple defects, diastasis, enterotomy, prior mesh failure]

Procedure(s) Performed

• [Primary repair with approach and mesh plane, e.g., "Open ventral incisional hernia repair with retromuscular mesh reinforcement"]
• [Additional procedures: significant adhesiolysis, component separation with type and laterality, mesh explant, enterotomy repair, bowel resection, drain placement] (Include only clinically meaningful additional procedures)

Indications

[Symptoms or functional impact prompting repair; rationale for chosen approach if relevant; contamination context if applicable] (2–4 sentences; do not infer—document only what is known)

Operative Findings

Hernia location: [Midline vs lateral; anatomic landmarks; classification code if used]

Defect size: [Maximum length × maximum width in cm; internal vs external measurement; for multiple defects include individual sizes and overall field span] (Core data—if not measured, explicitly state why)

Hernia contents: [Structures reduced; viability status if incarcerated]

Adhesions: [Location, severity, whether adhesiolysis required]

Prior mesh: [Present / absent; if present: intact vs failed; removed vs left in situ]

Field status: [clean / clean-contaminated / contaminated / dirty] [Specify relevant features: enterotomy, spillage, infection, abscess]

Abdominal wall quality: [Fascia quality, rectus retraction, loss of domain assessment, diastasis]

Operative Technique

(Chronological narrative with sufficient detail for another surgeon to understand exactly what was done; avoid vague phrases like "standard fashion" without key specifics)

Access and entry: [Approach: open / laparoscopic / robotic]. [Incision type and location OR entry technique and port placement]. [Any access complications and management].

Adhesiolysis: [Purpose, extent, technique, any serosal or enteric injuries with management]. (Include only if more than minimal)

Hernia sac management: [Contents reduced; viability confirmed; sac excision vs reduction; peritoneal flap management if applicable].

Fascial closure: [Primary closure achieved / bridged repair]. [Suture type and size, running vs interrupted, single vs layered]. [Posterior layer closure if performed]. (If closure not achieved, document why and alternative used)

Component separation/myofascial release: [Technique: anterior external oblique release / posterior TAR / other]. [Laterality: unilateral / bilateral]. [Extent and peritoneal flap reconstruction if applicable]. (Include only if performed)

Mesh implantation: [Plane: retromuscular / preperitoneal / intraperitoneal / onlay]. [Type: permanent synthetic / absorbable synthetic / biologic; barrier-coated if intraperitoneal]. [Product: manufacturer, product name, size, trimmed dimensions if applicable]. [Overlap beyond defect edges in cm]. [Fixation: transfascial sutures with number and pattern / tacks with type and pattern / glue / bone-ligament fixation]. [Orientation: barrier side toward viscera confirmed if applicable]. (If contaminated field, document rationale for mesh choice)

Drains: [Number, type, size, anatomic plane, laterality, exit sites]. (Omit if no drains placed)

Hemostasis and irrigation: [Hemostasis achieved; hemostatic agents with product name and location if used].

Closure and dressing: [Layered closure sequence with suture materials]. [Local anesthetic infiltration if performed]. [Dressing type; negative pressure wound therapy if applied].

Implants

Mesh: [Product name, manufacturer, size, anatomic plane, lot number/UDI if available]

Explant: [Mesh removed: partial vs complete; reason for removal] (Include only if mesh was explanted)

Specimens

[Specimen type and destination: pathology or microbiology] (Omit section entirely if no specimens sent)

Estimated Blood Loss

[Numeric estimate in mL] (If not assessed, document "per anesthesia record")

Complications

[None / List each complication with intraoperative management] (Required field—never leave blank)

Disposition

[Patient condition: stable, extubated in OR / intubated]. [Destination: PACU / floor / ICU]. [Immediate concerns if any].

Postoperative Plan

• [Diet advancement plan]
• [Activity restrictions and abdominal binder instructions]
• [Pain management; note TAP block if performed]
• [Antibiotic plan and duration]
• [VTE prophylaxis]
• [Drain management: output recording and removal criteria] (Include only if drains placed)
• [Wound care: dressing changes, showering, suture/staple removal]
• [Follow-up timing and service]
• [Warning signs for escalation]

Signature: [Surgeon name, credentials] — [Date and time of completion]