Inguinal Hernia Repair (Pediatric)
[Right / left / bilateral] inguinal hernia
Same
[Right / left / bilateral] inguinal hernia repair with high ligation of patent processus vaginalis
[***, MD/DO]
[Resident name]
[General / combined general + caudal block]
Patient is a [X]-[year/month/day]-old [male / female] [born at [X] weeks gestation, current postconception age [X] weeks] with [right / left / bilateral] inguinal hernia noted on exam. [No episodes of incarceration.] [Contralateral examination with laparoscope planned.] Risks including recurrence, testicular atrophy / oophorectomy risk, vas deferens injury, and wound infection discussed with parents. Consent obtained.
[Right / left] patent processus vaginalis (indirect inguinal hernia). [Bilateral patent processus vaginalis confirmed on contralateral laparoscopic inspection.] [No incarcerated contents / Incarcerated [bowel / ovary / omentum] reduced and viable.] Vas deferens and gonadal vessels identified and protected during sac dissection.
The patient was positioned supine. [Caudal block placed by anesthesia.] The [right / left] groin was prepped and draped.
A transverse incision was made in the right [/ left] lower abdominal skin crease. Scarpa's fascia was opened. The external oblique fascia was identified and opened along the external inguinal ring. [The ilioinguinal nerve was protected where encountered.] The spermatic cord [/ round ligament] was encircled with a Penrose drain.
The hernia sac (patent processus vaginalis) was identified on the anteromedial aspect of the cord and carefully dissected free from the vas deferens and gonadal vessels using blunt and sharp dissection. The sac was twisted and ligated at the internal ring with [2-0 / 3-0 Vicryl]. The sac was amputated distally. [For scrotal/hydrocele cases: the distal sac was opened widely and left open to prevent hydrocele formation.] Hemostasis confirmed. The internal ring was inspected [closed adequately / snug closure with one finger breadth admitted].
[Contralateral internal ring inspection was performed by passing the laparoscope through the hernia sac into the peritoneal cavity. [No contralateral patent processus vaginalis / contralateral PPV confirmed and repaired bilaterally].]
[Testis confirmed in scrotal position at conclusion of case.]
External oblique fascia closed with [3-0 Vicryl]. Scarpa's fascia approximated. Skin closed with [4-0 Monocryl / Steri-Strips]. Patient tolerated the procedure well.
None
None
Minimal
None
Patient to PACU. Discharged home after recovery. [Former preterm infants: admitted for 12-24 hour apnea monitoring.]
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: [Right / left / bilateral] inguinal hernia
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: [Right / left / bilateral] inguinal hernia repair with high ligation of patent processus vaginalis
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: General [+ caudal block]
INDICATIONS: The patient is a .PTAGE-old .PTSEX [born at *** weeks gestation, postconception age *** weeks, weight *** kg] with [right / left / bilateral] inguinal hernia. No prior incarceration. Risks including recurrence, gonadal injury, and vas deferens injury discussed with parents. Informed consent obtained.
FINDINGS: [Right / left] patent processus vaginalis (indirect inguinal hernia). [Contralateral PPV confirmed / not present on laparoscopic inspection.] [No incarcerated contents / Incarcerated [bowel / ovary] — reduced, viable.] Vas deferens and gonadal vessels identified and protected.
DESCRIPTION OF PROCEDURE:
Patient supine. [Caudal block by anesthesia.] Transverse groin crease incision. Scarpa's fascia opened. External oblique fascia opened along external ring. [Ilioinguinal nerve protected where encountered.] Spermatic cord [/ round ligament] encircled with Penrose. Hernia sac (PPV) identified on anteromedial cord, dissected free from vas and gonadal vessels, twisted, and ligated at internal ring with 2-0 Vicryl. Sac amputated. [Distal sac opened and left open (hydrocele case).] Internal ring inspected and closed adequately. [Contralateral inspection via laparoscope through sac: [no PPV / PPV confirmed and repaired].] [Testis confirmed in scrotum.] External oblique fascia closed with 3-0 Vicryl. Scarpa's fascia approximated. Skin closed with 4-0 Monocryl. Patient tolerated procedure well.
ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: None
COMPLICATIONS: None
DRAINS: None
DISPOSITION: Patient to PACU. [Discharged home / Admitted for apnea monitoring (former preterm).]
Signed: .ME, .MYDEGREE
.TODAYVariants
Preterm infant repair
For infants born at <37 weeks gestation presenting before 50 weeks postconception age. Low-weight-infant reporting applies if weight <4 kg. Plan postoperative apnea monitoring (12-24 hr) for former preterm infants with corrected gestational age <44 weeks.
Incarcerated / irreducible inguinal hernia
Attempt gentle manual reduction before OR if no signs of strangulation. Document sac contents (bowel, ovary, omentum), reducibility, and viability.
Bilateral inguinal hernia repair
Apply bilateral-procedure reporting to the appropriate age-based code. Medicare and most commercial payers pay 150% of the unilateral fee for bilateral procedures. Document both sides with separate findings.
Sliding inguinal hernia
Common in female infants, where ovary or fallopian tube forms part of the sac wall. Do not excise the sac — reduce the ovary and close the internal ring around the tube and its blood supply. Document sac contents and technique used to manage the sliding component.
Laparoscopic repair (PIRS)
Umbilical camera port; laparoscopic visualization of internal ring; percutaneous purse-string closure with spinal needle (PIRS technique) or intracorporeal suturing. Bilateral exploration and repair is straightforward laparoscopically.
Concurrent orchiopexy for undescended testis
Document preoperative location of testis, mobilization steps, and fixation in the scrotum.
Charting Tips
- Document age at surgery and use the correct age tier for reporting selection.
- Document weight at surgery for low-weight-infant reporting eligibility (<4 kg)
- State identification and protection of vas deferens and gonadal vessels explicitly
- Document reducibility (reducible vs. incarcerated/strangulated) — determines the code pair (even = reducible, odd = incarcerated for each age tier)
- Note whether contralateral exploration was performed and findings
- Document ligation level: at the internal ring (high ligation) is standard
- For males, confirm testicular position in the scrotum at case conclusion — document explicitly
Documentation & Reimbursement Considerations
- Report Inguinal Hernia Repair (Pediatric) as the primary service when it is the definitive operation performed.
- Reporting selection is strictly age-based for open repair. Age is determined at the time of the procedure, not at consultation.
- Document both sides explicitly.
- Adds approximately 22.6% to the fee. Document weight at time of surgery.
- Do not separately bill hydrocelectomy reporting options in that setting. Document hydrocele management in the note but do not submit a separate reporting options for it.
- This is a common concurrent pediatric procedure. Document the undescended testis, its location, and that it was mobilized and fixed in the scrotum.
- 90-day global: routine postoperative visit is bundled. Hydrocele or recurrence presenting after the global period are separately billable.