Surgical Outpatient Consultation Letter

Clinician Specialty: General Surgeon 1 November 2024 Dr. Sarah Jenkins, City General Practice, 123 Health Lane, London SW1A 1AA Mr. John Smith, DOB: 15/03/1970 Dear Dr. Jenkins, Diagnosis / Ongoing Issues: Right inguinal hernia Past Medical History: Hypertension (controlled with medication) Appendectomy (1995) Allergy: Penicillin (rash) BMI: 28.5 kg/m² (Overweight) Smoking / Alcohol: Non-smoker Alcohol: Social drinker, 2-3 units per week Performance Status: ECOG Performance Status 0 - Fully active, able to carry on all pre-disease performance without restriction. Management Plan: Elective right inguinal hernia repair with mesh. Mr. Smith presented with a several-month history of a reducible lump in his right groin, which becomes more prominent on standing and coughing. He reports intermittent discomfort, particularly after prolonged standing or heavy lifting, but denies any acute pain, nausea, or vomiting. He has not experienced any changes in bowel habits or urinary symptoms. Relevant investigations to date include a clinical examination by his GP and a recent ultrasound scan confirming a right inguinal hernia with no evidence of strangulation or incarceration. The condition has impacted his ability to perform certain physical tasks at work and recreational activities. Physical examination revealed a reducible right inguinal hernia that increased in size with Valsalva maneuver. There was no tenderness to palpation, and no signs of inflammation or skin changes. Point-of-care ultrasound confirmed the presence of a reducible right inguinal hernia sac containing omentum, approximately 3 cm in diameter, with no evidence of obstruction. The possible diagnosis is a right inguinal hernia, and the recommended treatment is an elective laparoscopic inguinal hernia repair with mesh. Further investigations are not deemed necessary at this stage given the clear clinical and ultrasound findings. We discussed the benefits of repair, primarily symptom relief and prevention of complications such as incarceration or strangulation. Follow-up arrangements include a pre-operative assessment within the next two weeks at the hospital's pre-assessment clinic. The surgical procedure is planned for approximately 4-6 weeks from today. Mr. Smith will be contacted directly by the scheduling department. Dr. Kelly will be the operating surgeon. Surgical risks discussed with the patient relevant to the procedure recommended: General or local anaesthetic risks Bleeding Infection Recurrence Chronic groin pain Seroma Injury to the vas deferens or testicular vessels Mesh complications Conversion between laparoscopic and open approach Mr. Smith was advised he may contact the surgeon via email or book a telephone consultation to discuss surgical risks and alternative treatment options. Dr. Thomas Kelly, FRCS, Consultant General Surgeon Royal Infirmary, Glasgow contact@drkelly.com