Preoperative Diagnosis: @ORPREDX@*** Postoperative Diagnosis: Same @ORPROCALL@ Performing Service: @ORSERV@ @ORSURROLE@ Assistant(s): None Anesthesia: @ORANEST@ Fluids: See anesthesia record Estimated blood loss: @ORBLDLOSS@ Complications: None Specimens: @ORSPEC@ Drains: {BJM Drain:43445} @ORIMPLANT3@ Indications: @AGE@ @SEX@ with ***. Risks, benefits, and alternatives of the above procedure were discussed and informed consent was signed. OperativeFindings: *** Description: The patient was brought to the operating room and underwent general anesthesia. He was placed in the supine position. His genitalia was shaved, prepped and draped in the usual fashion. A timeout was conducted. The *** testis was firm with a surrounding hydrocele. A 5 cm horizontal incision was made in the *** hemiscrotum. Cautery was used to dissect through the layers of the dartos. The tunica vaginalis was opened, and a moderate amount of clear fluid was expelled. The testis was then delivered. The testis and epididymis were dark and congested consistent with long standing ischemia. There appeared to be a "bell-clapper" deformity to the tunica vaginalis. There was a 360 degree torsion which was relieved. The testis was then wrapped in moist gauze to see if it would perfuse while we worked on the contralateral side. A 5 cm horizontal incision was made in the *** hemiscrotum. Cautery was used to dissect through the layers of the dartos. The tunica vaginalis was opened, and the testis was then delivered. The testis and epididymis were entirely normal. There appeared to be a bit of "bell-clapper" deformity to the tunica vaginalis. The appendix epididymis was identified and removed with cautery to prevent a potential cause of acute scrotum in the future. Three fixation sutures of 3-0 Ticron were placed in the tunica albuginea at 10:00, 2:00 and 6:00. These sutures were then sewn to the inside of the scrotum in the appropriate positions. The testis was placed back into its hemiscrotum, and the sutures were tied down. The dartos layer was closed with running 4-0 Monocryl. The skin was closed with horizontal sutures of 4-0 chromic. Attention was then placed on the right testis. The epididymis was now completely pink. The testis was still dusky but much softer. Based on this improvement, I chose to keep the testis and perform an orchiopexy. The appendix epididymis was identified and removed with cautery to prevent a potential cause of acute scrotum in the future. Three fixation sutures of 3-0 Ticron were placed in the tunica albuginea at 10:00, 2:00 and 6:00. Bleeding of red blood was noted to further confirm normal blood flow. These sutures were then sewn to the inside of the scrotum in the appropriate positions. The testis was placed back into its hemiscrotum, and the sutures were tied down. The dartos layer was closed with running 4-0 Monocryl. The skin was closed with horizontal sutures of 4-0 chromic. The wound edges were infiltrated with 0.20% ropivacaine. Indermil was placed over both incisions. A scrotal support and dry gauze were placed. The patient tolerated the procedure well, and there were no complications. Final counts were correct. Post Op Plan: - Discharge patient to {bjmfloor:41961} when meets PACU criteria. {fu:44396}