from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import PageBreak
from datetime import date

OUTPUT = "/tmp/workspace/ventral-hernia/Ventral_Hernia_Clinical_Profile.pdf"

# ─── Colour palette ───────────────────────────────────────────────────────────
NAVY    = colors.HexColor("#1A3A5C")
TEAL    = colors.HexColor("#2A7B8C")
ACCENT  = colors.HexColor("#E8F4F8")
LIGHT   = colors.HexColor("#F5F9FC")
ORANGE  = colors.HexColor("#D4630A")
LGREY   = colors.HexColor("#E0E0E0")
WHITE   = colors.white
BLACK   = colors.black
DARKGREY= colors.HexColor("#555555")

# ─── Styles ───────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

def S(name, **kw):
    return ParagraphStyle(name, **kw)

title_style = S("Title",
    fontName="Helvetica-Bold", fontSize=22, textColor=WHITE,
    alignment=TA_CENTER, spaceAfter=4)

subtitle_style = S("Subtitle",
    fontName="Helvetica", fontSize=13, textColor=colors.HexColor("#BEE0EB"),
    alignment=TA_CENTER, spaceAfter=2)

date_style = S("Date",
    fontName="Helvetica", fontSize=10, textColor=colors.HexColor("#90C8D8"),
    alignment=TA_CENTER, spaceAfter=0)

section_style = S("Section",
    fontName="Helvetica-Bold", fontSize=13, textColor=WHITE,
    spaceAfter=0, spaceBefore=0)

body_style = S("Body",
    fontName="Helvetica", fontSize=10, textColor=BLACK,
    leading=15, spaceAfter=4, alignment=TA_JUSTIFY)

bullet_style = S("Bullet",
    fontName="Helvetica", fontSize=10, textColor=BLACK,
    leading=14, spaceAfter=2, leftIndent=14, firstLineIndent=-10)

bold_label = S("BoldLabel",
    fontName="Helvetica-Bold", fontSize=10, textColor=NAVY,
    spaceAfter=2)

sub_heading = S("SubHeading",
    fontName="Helvetica-Bold", fontSize=11, textColor=NAVY,
    spaceBefore=8, spaceAfter=4)

table_header = S("TblHdr",
    fontName="Helvetica-Bold", fontSize=9, textColor=WHITE,
    alignment=TA_CENTER)

table_cell = S("TblCell",
    fontName="Helvetica", fontSize=9, textColor=BLACK,
    leading=12)

footer_style = S("Footer",
    fontName="Helvetica-Oblique", fontSize=8, textColor=DARKGREY,
    alignment=TA_CENTER)

# ─── Header / Footer callback ─────────────────────────────────────────────────
def on_page(canvas, doc):
    w, h = A4
    # Top stripe
    canvas.setFillColor(NAVY)
    canvas.rect(0, h - 18*mm, w, 18*mm, fill=1, stroke=0)
    canvas.setFillColor(TEAL)
    canvas.rect(0, h - 20*mm, w, 2*mm, fill=1, stroke=0)
    canvas.setFont("Helvetica-Bold", 9)
    canvas.setFillColor(WHITE)
    canvas.drawString(20*mm, h - 13*mm, "VENTRAL HERNIA — CLINICAL PROFILE")
    canvas.drawRightString(w - 20*mm, h - 13*mm,
        f"Date: {date.today().strftime('%d %B %Y')}")

    # Bottom stripe
    canvas.setFillColor(TEAL)
    canvas.rect(0, 0, w, 10*mm, fill=1, stroke=0)
    canvas.setFont("Helvetica", 8)
    canvas.setFillColor(WHITE)
    canvas.drawCentredString(w/2, 3.5*mm,
        f"Page {doc.page}  |  Prepared for surgical planning  |  Confidential — For clinical use only")

def first_page(canvas, doc):
    on_page(canvas, doc)

# ─── Section banner helper ─────────────────────────────────────────────────────
def section_banner(title, icon=""):
    data = [[Paragraph(f"{icon}  {title}", section_style)]]
    t = Table(data, colWidths=[170*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), NAVY),
        ("TOPPADDING",    (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 10),
        ("ROUNDEDCORNERS", [4]),
    ]))
    return [t, Spacer(1, 4)]

def sub_banner(title):
    data = [[Paragraph(title, S("sb", fontName="Helvetica-Bold", fontSize=10,
                                textColor=NAVY))]]
    t = Table(data, colWidths=[170*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), ACCENT),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("LINEBELOW",     (0,0), (-1,-1), 1, TEAL),
    ]))
    return [t, Spacer(1, 4)]

def bullet(text):
    return Paragraph(f"\u2022  {text}", bullet_style)

def body(text):
    return Paragraph(text, body_style)

def bold(text):
    return Paragraph(text, bold_label)

def sp(n=6):
    return Spacer(1, n)

# ─── Build content ────────────────────────────────────────────────────────────
story = []

# ════ COVER HEADER ═══════════════════════════════════════════════════════════
cover_data = [[
    Paragraph("CLINICAL CASE PROFILE", title_style),
    Paragraph("Ventral Hernia Reduction & Abdominal Wall Repair", subtitle_style),
    Paragraph(f"Prepared: {date.today().strftime('%d %B %Y')}  |  Surgery Department", date_style),
]]

cover_tbl = Table([[Paragraph("CLINICAL CASE PROFILE", title_style)],
                   [Paragraph("Ventral Hernia Reduction & Abdominal Wall Repair", subtitle_style)],
                   [Paragraph(f"Prepared: {date.today().strftime('%d %B %Y')}  |  Surgery Department", date_style)]],
                  colWidths=[170*mm])
cover_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), NAVY),
    ("TOPPADDING",    (0,0), (-1,-1), 12),
    ("BOTTOMPADDING", (0,0), (-1,-1), 12),
    ("LEFTPADDING",   (0,0), (-1,-1), 14),
    ("RIGHTPADDING",  (0,0), (-1,-1), 14),
]))
story += [sp(10), cover_tbl, sp(10)]

# ════ 1. PATIENT DEMOGRAPHICS ════════════════════════════════════════════════
story += section_banner("1.  PATIENT DEMOGRAPHICS")
demo_data = [
    [Paragraph("<b>Parameter</b>", table_header), Paragraph("<b>Details</b>", table_header)],
    [Paragraph("Name", table_cell), Paragraph("______________________________", table_cell)],
    [Paragraph("Age", table_cell), Paragraph("45 Years", table_cell)],
    [Paragraph("Sex", table_cell), Paragraph("Female", table_cell)],
    [Paragraph("MRN / Hospital No.", table_cell), Paragraph("______________________________", table_cell)],
    [Paragraph("Ward / Bed", table_cell), Paragraph("______________________________", table_cell)],
    [Paragraph("Admitting Surgeon", table_cell), Paragraph("______________________________", table_cell)],
    [Paragraph("Scheduled Procedure", table_cell), Paragraph("Ventral Hernia Reduction + Abdominal Wall Repair", table_cell)],
    [Paragraph("Planned Date", table_cell), Paragraph("______________________________", table_cell)],
    [Paragraph("Anaesthesia Type", table_cell), Paragraph("General Anaesthesia (planned)", table_cell)],
]
demo_tbl = Table(demo_data, colWidths=[55*mm, 115*mm])
demo_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), TEAL),
    ("BACKGROUND",    (0,1), (-1,-1), WHITE),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT, WHITE]),
    ("GRID",          (0,0), (-1,-1), 0.5, LGREY),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
]))
story += [demo_tbl, sp(10)]

# ════ 2. DIAGNOSIS ═══════════════════════════════════════════════════════════
story += section_banner("2.  DIAGNOSIS & CLASSIFICATION")
story += [
    sp(4),
    bold("Primary Diagnosis:"),
    bullet("Ventral Hernia (symptomatic)"),
    sp(4),
    bold("Definition:"),
    body("A ventral hernia is a protrusion of abdominal contents through a defect in the anterior "
         "abdominal wall. It encompasses primary hernias (epigastric, umbilical, Spigelian) and "
         "incisional hernias. Repair of ventral abdominal wall hernia is one of the most common "
         "procedures performed by a general surgeon."),
    sp(4),
]

# Classification table
story += sub_banner("European Hernia Society (EHS) Classification — Incisional Hernias")
cls_data = [
    [Paragraph("<b>Criterion</b>", table_header), Paragraph("<b>Category</b>", table_header), Paragraph("<b>Detail</b>", table_header)],
    [Paragraph("Localization", table_cell), Paragraph("Midline / Lateral", table_cell), Paragraph("Specify anatomic location", table_cell)],
    [Paragraph("Size (width)", table_cell), Paragraph("W1 < 4 cm\nW2 4–10 cm\nW3 > 10 cm", table_cell), Paragraph("Measured at widest point", table_cell)],
    [Paragraph("Recurrence", table_cell), Paragraph("Primary / Recurrent", table_cell), Paragraph("Number of prior repairs", table_cell)],
    [Paragraph("Symptoms", table_cell), Paragraph("Asymptomatic / Symptomatic", table_cell), Paragraph("Pain, restriction of activities", table_cell)],
]
cls_tbl = Table(cls_data, colWidths=[45*mm, 60*mm, 65*mm])
cls_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT, WHITE]),
    ("GRID",          (0,0), (-1,-1), 0.5, LGREY),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story += [cls_tbl, sp(10)]

# ════ 3. PATHOPHYSIOLOGY ═════════════════════════════════════════════════════
story += section_banner("3.  PATHOPHYSIOLOGY")
story += [
    sp(4),
    body("Ventral hernias result from failure or disruption of the abdominal wall fascia. "
         "The anterior abdominal wall consists of rectus abdominis muscles with the aponeuroses "
         "of the external oblique, internal oblique, and transversus abdominis forming the rectus "
         "sheath. A defect allows peritoneal fat or intraabdominal contents (omentum, bowel) to "
         "herniate through, creating a hernia sac."),
    sp(4),
    bold("Risk factors contributing to defect formation:"),
    bullet("Midline laparotomy incisions (highest risk for incisional hernias)"),
    bullet("Obesity — increases intraabdominal pressure"),
    bullet("Collagen metabolism defects (connective tissue disorders, AAA history)"),
    bullet("Corticosteroid use, chemotherapy, malnutrition, hypoalbuminaemia"),
    bullet("Poor surgical closure technique — inadequate fascial bites, suture under tension"),
    bullet("Wound infection post-laparotomy"),
    bullet("Pulmonary disease / chronic cough"),
    bullet("Smoking"),
    sp(4),
    bold("Consequences of unrepaired enlarging hernias:"),
    bullet("Loss of abdominal domain"),
    bullet("Biomechanical alterations affecting posture and core stability"),
    bullet("Incarceration or strangulation (Read & Yoder: 17% of incisional hernias at presentation)"),
    bullet("Compromise of activities of daily living"),
    sp(8),
]

# ════ 4. PREOPERATIVE ASSESSMENT ═════════════════════════════════════════════
story += section_banner("4.  PREOPERATIVE ASSESSMENT & OPTIMISATION")
story += [
    sp(4),
]
story += sub_banner("History & Physical")
story += [
    bullet("Duration, onset, and progression of hernia"),
    bullet("Symptoms: pain, irreducibility, nausea/vomiting (bowel obstruction signs)"),
    bullet("Prior abdominal surgeries and hernia repairs"),
    bullet("BMI — morbid obesity is a relative contraindication to elective mesh repair without optimisation"),
    bullet("Cardiorespiratory history (impacts anaesthesia planning)"),
    bullet("Medications: steroids, anticoagulants, NSAIDs"),
    bullet("Smoking history — cessation recommended ≥4 weeks preoperatively"),
    sp(4),
]
story += sub_banner("Investigations")
invest_data = [
    [Paragraph("<b>Investigation</b>", table_header), Paragraph("<b>Purpose</b>", table_header)],
    [Paragraph("FBC, U&E, LFTs, Coagulation", table_cell), Paragraph("Baseline bloods, anaesthetic fitness", table_cell)],
    [Paragraph("Serum albumin", table_cell), Paragraph("Nutritional status (hypoalbuminaemia increases complications)", table_cell)],
    [Paragraph("ECG + CXR", table_cell), Paragraph("Cardiac and pulmonary baseline", table_cell)],
    [Paragraph("CT Abdomen & Pelvis (with contrast)", table_cell), Paragraph("Hernia defect size, loss of domain, bowel involvement, anatomy planning", table_cell)],
    [Paragraph("Blood glucose / HbA1c", table_cell), Paragraph("Diabetic optimisation (wound healing)", table_cell)],
    [Paragraph("Group & Screen", table_cell), Paragraph("Anticipate blood loss in large repairs", table_cell)],
    [Paragraph("Pulmonary function tests", table_cell), Paragraph("If large hernia with loss of domain — abdominal closure may restrict diaphragm", table_cell)],
]
inv_tbl = Table(invest_data, colWidths=[70*mm, 100*mm])
inv_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT, WHITE]),
    ("GRID",          (0,0), (-1,-1), 0.5, LGREY),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story += [inv_tbl, sp(6)]
story += sub_banner("Optimisation Targets Before Surgery")
story += [
    bullet("BMI < 35 kg/m² preferred for elective mesh repair"),
    bullet("Blood sugar control — HbA1c < 8%"),
    bullet("Smoking cessation"),
    bullet("Nutritional support if serum albumin < 30 g/L"),
    bullet("Treatment of active skin infections or wounds over hernia"),
    bullet("Thromboprophylaxis planning (DVT risk elevated by prolonged surgical time)"),
    sp(10),
]

# ════ 5. SURGICAL MANAGEMENT ═════════════════════════════════════════════════
story += section_banner("5.  SURGICAL MANAGEMENT")
story += [sp(4)]
story += sub_banner("Indications for Repair")
story += [
    bullet("Symptomatic hernia (pain, restriction of activities)"),
    bullet("Enlarging defect"),
    bullet("Risk of incarceration or strangulation"),
    bullet("Loss of abdominal domain"),
    bullet("Patient preference after informed consent"),
    sp(6),
]
story += sub_banner("Surgical Approaches")
approach_data = [
    [Paragraph("<b>Approach</b>", table_header),
     Paragraph("<b>Description</b>", table_header),
     Paragraph("<b>Best suited for</b>", table_header)],
    [Paragraph("Open Primary Suture Repair", table_cell),
     Paragraph("Fascial edges approximated with slowly absorbable monofilament suture; small bites 5 mm apart (STITCH trial principles)", table_cell),
     Paragraph("Small defects (<2 cm); contaminated field", table_cell)],
    [Paragraph("Open Mesh Repair\n(Rives-Stoppa / Retromuscular)", table_cell),
     Paragraph("Mesh placed in the retromuscular / preperitoneal space. Lowest recurrence and SSI risk. Preferred elective approach.", table_cell),
     Paragraph("Medium–large defects; elective setting", table_cell)],
    [Paragraph("Laparoscopic IPOM\n(Intraperitoneal Onlay Mesh)", table_cell),
     Paragraph("Barrier-coated mesh placed intraperitoneally with tacker/suture fixation. Minimally invasive.", table_cell),
     Paragraph("Moderate defects; good laparoscopic candidates", table_cell)],
    [Paragraph("Robotic / MIS Retromuscular\n(TARUP / rTAR)", table_cell),
     Paragraph("Robotic-assisted retromuscular dissection allowing mesh placement in optimal plane with minimal wound morbidity", table_cell),
     Paragraph("Large defects; obesity; complex anatomy", table_cell)],
    [Paragraph("Abdominal Wall Reconstruction\n(Component Separation)", table_cell),
     Paragraph("Myofascial release (anterior or posterior component separation — TAR) allows medial advancement of muscle layers to close large defects", table_cell),
     Paragraph("Giant hernias; loss of domain; recurrent hernias", table_cell)],
]
app_tbl = Table(approach_data, colWidths=[45*mm, 80*mm, 45*mm])
app_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT, WHITE]),
    ("GRID",          (0,0), (-1,-1), 0.5, LGREY),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ("FONTSIZE",      (0,1), (-1,-1), 9),
]))
story += [app_tbl, sp(6)]

story += sub_banner("Mesh Position (ICAP Classification 2019)")
mesh_data = [
    [Paragraph("<b>Position</b>", table_header), Paragraph("<b>Description</b>", table_header), Paragraph("<b>Comment</b>", table_header)],
    [Paragraph("Onlay", table_cell), Paragraph("Anterior to rectus sheath / ext. oblique aponeurosis", table_cell), Paragraph("Higher SSI, seroma risk", table_cell)],
    [Paragraph("Inlay (Interposition)", table_cell), Paragraph("Between muscle layers bridging defect", table_cell), Paragraph("AVOID in elective repair — high recurrence", table_cell)],
    [Paragraph("Retromuscular (Sublay)", table_cell), Paragraph("Between rectus muscle and posterior sheath", table_cell), Paragraph("PREFERRED — lowest recurrence + SSI", table_cell)],
    [Paragraph("Preperitoneal (Sublay)", table_cell), Paragraph("Between transversalis fascia and peritoneum", table_cell), Paragraph("Good plane; used in TEP/TAPP-type repairs", table_cell)],
    [Paragraph("Intraperitoneal (IPOM)", table_cell), Paragraph("Inside abdomen on peritoneum (barrier mesh)", table_cell), Paragraph("Laparoscopic approach; visceral contact", table_cell)],
]
mesh_tbl = Table(mesh_data, colWidths=[40*mm, 75*mm, 55*mm])
mesh_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT, WHITE]),
    ("GRID",          (0,0), (-1,-1), 0.5, LGREY),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story += [mesh_tbl, sp(10)]

# ════ 6. ANAESTHESIA CONSIDERATIONS ══════════════════════════════════════════
story += section_banner("6.  ANAESTHESIA CONSIDERATIONS")
story += [
    sp(4),
    bold("Type:"),
    bullet("General anaesthesia is standard for open and laparoscopic ventral hernia repair"),
    bullet("Regional / spinal anaesthesia considered for high pulmonary risk patients undergoing small open repairs"),
    sp(4),
    bold("Key anaesthetic concerns:"),
    bullet("Airway assessment (BMI, neck mobility, Mallampati)"),
    bullet("Aspiration risk — ventral hernia may cause gastroparesis/reflux"),
    bullet("Pneumoperitoneum in laparoscopic repair causes hypercapnia — ensure adequate ventilation compensation"),
    bullet("Neuromuscular blockade needed for adequate muscle relaxation during closure"),
    bullet("Hypothermia prevention (long operative time in abdominal wall reconstruction)"),
    bullet("Fluid management — avoid overhydration (increases bowel oedema, complicates closure)"),
    sp(8),
]

# ════ 7. INTRAOPERATIVE STEPS ════════════════════════════════════════════════
story += section_banner("7.  INTRAOPERATIVE STEPS — OPEN RETROMUSCULAR MESH REPAIR")
story += [sp(4)]
steps = [
    ("1. Patient Positioning", "Supine with arms extended; bladder catheterisation; DVT prophylaxis stockings applied"),
    ("2. Skin Preparation & Draping", "Wide prep from nipples to thighs; standard sterile draping"),
    ("3. Incision", "Midline or over prior scar; careful dissection through subcutaneous tissue to fascia"),
    ("4. Hernia Sac Identification", "Identify hernia sac; carefully dissect and reduce contents back into peritoneal cavity"),
    ("5. Fascial Defect Assessment", "Measure defect width and height; assess tissue quality bilaterally"),
    ("6. Retromuscular Space Creation", "Dissect posterior rectus sheath off rectus muscle bilaterally; extend retromuscular space laterally"),
    ("7. Posterior Sheath Closure", "Close posterior sheath / peritoneum in midline with slowly absorbable running suture"),
    ("8. Mesh Placement", "Place large-pore polypropylene mesh in retromuscular space; overlap defect edge by ≥5 cm on all sides"),
    ("9. Mesh Fixation", "Secure mesh with transfascial sutures at corners; tack fixation if laparoscopic"),
    ("10. Anterior Sheath Closure", "Approximate anterior rectus sheath in midline; slowly absorbable monofilament; 4:1 suture-to-wound length ratio"),
    ("11. Drain Placement", "Closed suction drain in subcutaneous space (if large flap raised)"),
    ("12. Skin Closure", "Subcuticular suture or staples"),
]
for num, (step, desc) in enumerate(steps):
    row_bg = LIGHT if num % 2 == 0 else WHITE
    step_data = [[Paragraph(f"<b>{step}</b>", S("s", fontName="Helvetica-Bold",
                 fontSize=9, textColor=NAVY)),
                  Paragraph(desc, table_cell)]]
    step_tbl = Table(step_data, colWidths=[55*mm, 115*mm])
    step_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), row_bg),
        ("GRID",          (0,0), (-1,-1), 0.5, LGREY),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]))
    story.append(step_tbl)
story.append(sp(10))

# ════ 8. COMPONENT SEPARATION (if needed) ════════════════════════════════════
story += section_banner("8.  ABDOMINAL WALL RECONSTRUCTION — COMPONENT SEPARATION")
story += [
    sp(4),
    body("For large defects where primary fascial approximation would be under undue tension, a "
         "myofascial release (component separation) is performed. The two main techniques are:"),
    sp(4),
]
cs_data = [
    [Paragraph("<b>Technique</b>", table_header), Paragraph("<b>Steps</b>", table_header), Paragraph("<b>Advancement</b>", table_header)],
    [Paragraph("Anterior Component\nSeparation (ACS)\n[Ramirez technique]", table_cell),
     Paragraph("Skin/fat raised off anterior rectus sheath. External oblique aponeurosis transected longitudinally lateral to semilunar line, extended to inguinal lig. inferiorly and 5–7 cm above costal margin superiorly. External oblique separated from internal oblique in avascular plane to mid-axillary line.", table_cell),
     Paragraph("~5 cm at waist / ~10 cm at mid abdomen per side", table_cell)],
    [Paragraph("Posterior Component\nSeparation (PCS) /\nTransversus Abdominis\nRelease (TAR)", table_cell),
     Paragraph("Retromuscular plane developed. Posterior layer of internal oblique and transversus abdominis released. Large retromuscular/preperitoneal space created. Mesh placed in this space with excellent soft tissue coverage.", table_cell),
     Paragraph("~6–8 cm per side; preserves perforators, lower wound complication rate", table_cell)],
]
cs_tbl = Table(cs_data, colWidths=[40*mm, 95*mm, 35*mm])
cs_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT, WHITE]),
    ("GRID",          (0,0), (-1,-1), 0.5, LGREY),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ("FONTSIZE",      (0,1), (-1,-1), 9),
]))
story += [cs_tbl, sp(10)]

# ════ 9. POSTOPERATIVE CARE ═══════════════════════════════════════════════════
story += section_banner("9.  POSTOPERATIVE CARE")
story += [sp(4)]
story += sub_banner("Immediate (Day 0–1)")
story += [
    bullet("Monitoring: BP, HR, SpO2, urine output, wound check"),
    bullet("Analgesia: multimodal — paracetamol + NSAID + opioid PRN; TAP block or rectus sheath block for open repairs"),
    bullet("VTE prophylaxis: LMWH from 6–12 hours post-op + compression stockings"),
    bullet("IV fluids until tolerating oral intake"),
    bullet("Early ambulation within 12–24 hours"),
    sp(4),
]
story += sub_banner("Short-term (Days 2–7)")
story += [
    bullet("Transition to oral analgesia; step down opioids"),
    bullet("Wound assessment for signs of infection, seroma, haematoma"),
    bullet("Drain management — remove when output < 30 mL/24h"),
    bullet("Respiratory physiotherapy — incentive spirometry (large repairs restrict breathing)"),
    bullet("Diet: advance as tolerated; high-protein diet supports wound healing"),
    bullet("Monitor bowel function — ileus expected 2–3 days in open repairs"),
    sp(4),
]
story += sub_banner("Discharge Criteria")
story += [
    bullet("Afebrile, haemodynamically stable"),
    bullet("Tolerating oral intake, bowel function present"),
    bullet("Pain controlled on oral analgesia"),
    bullet("Wound dry and intact"),
    bullet("Patient educated on activity restrictions"),
    sp(4),
]
story += sub_banner("Post-Discharge Instructions")
post_data = [
    [Paragraph("<b>Item</b>", table_header), Paragraph("<b>Instruction</b>", table_header)],
    [Paragraph("Activity", table_cell), Paragraph("Light activity; no heavy lifting (>5 kg) for 6 weeks; no strenuous exercise for 3 months", table_cell)],
    [Paragraph("Abdominal binder", table_cell), Paragraph("Wear for 4–6 weeks post-operatively to support repair", table_cell)],
    [Paragraph("Wound care", table_cell), Paragraph("Keep dry for 48 hours; inspect daily; return if redness, discharge, or wound opens", table_cell)],
    [Paragraph("Follow-up", table_cell), Paragraph("Outpatient review at 2 weeks and 6 weeks; CT scan at 1 year if large repair", table_cell)],
    [Paragraph("Return to work", table_cell), Paragraph("Sedentary work: 2–3 weeks; manual labour: 6–12 weeks", table_cell)],
    [Paragraph("Warning signs", table_cell), Paragraph("Fever > 38°C, increasing pain, swelling, nausea/vomiting, wound breakdown — report immediately", table_cell)],
]
post_tbl = Table(post_data, colWidths=[40*mm, 130*mm])
post_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT, WHITE]),
    ("GRID",          (0,0), (-1,-1), 0.5, LGREY),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story += [post_tbl, sp(10)]

# ════ 10. COMPLICATIONS ═══════════════════════════════════════════════════════
story += section_banner("10. COMPLICATIONS")
story += [sp(4)]
comp_data = [
    [Paragraph("<b>Complication</b>", table_header),
     Paragraph("<b>Incidence</b>", table_header),
     Paragraph("<b>Prevention / Management</b>", table_header)],
    [Paragraph("Wound Infection / SSI", table_cell),
     Paragraph("5–15%", table_cell),
     Paragraph("Preop antibiotics; aseptic technique; skin prep; optimise diabetes/obesity", table_cell)],
    [Paragraph("Seroma", table_cell),
     Paragraph("Most common after large repairs", table_cell),
     Paragraph("Closed-suction drain; compression binder; needle aspiration if tense", table_cell)],
    [Paragraph("Haematoma", table_cell),
     Paragraph("2–5%", table_cell),
     Paragraph("Haemostasis; drain; avoid anticoagulants peri-op", table_cell)],
    [Paragraph("Recurrence", table_cell),
     Paragraph("1–20% (mesh) vs 40–60% (primary suture for large defects)", table_cell),
     Paragraph("Retromuscular mesh with adequate overlap; optimise risk factors", table_cell)],
    [Paragraph("Chronic Pain / Mesh Pain", table_cell),
     Paragraph("5–10%", table_cell),
     Paragraph("Lightweight mesh; avoid overtightening sutures; neuroma excision if needed", table_cell)],
    [Paragraph("Small Bowel Obstruction", table_cell),
     Paragraph("Rare with retromuscular repair", table_cell),
     Paragraph("Close peritoneum over mesh; close trocar sites >5 mm fascially", table_cell)],
    [Paragraph("Mesh Infection", table_cell),
     Paragraph("1–3%", table_cell),
     Paragraph("Biological mesh in contaminated field; IV antibiotics; debridement", table_cell)],
    [Paragraph("Incarceration / Strangulation\n(if not repaired)", table_cell),
     Paragraph("17% of incisional hernias at presentation", table_cell),
     Paragraph("Timely elective repair prevents emergency presentation", table_cell)],
    [Paragraph("Pneumonia / Atelectasis", table_cell),
     Paragraph("Increased with large repairs", table_cell),
     Paragraph("Early mobilisation; incentive spirometry; physiotherapy", table_cell)],
    [Paragraph("DVT / PE", table_cell),
     Paragraph("1–3%", table_cell),
     Paragraph("LMWH + TED stockings; early ambulation", table_cell)],
]
comp_tbl = Table(comp_data, colWidths=[45*mm, 30*mm, 95*mm])
comp_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT, WHITE]),
    ("GRID",          (0,0), (-1,-1), 0.5, LGREY),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ("FONTSIZE",      (0,1), (-1,-1), 9),
]))
story += [comp_tbl, sp(10)]

# ════ 11. VENTRAL HERNIA WORKING GROUP (VHWG) GRADE ═════════════════════════
story += section_banner("11. VHWG WOUND RISK CLASSIFICATION")
story += [sp(4)]
vhwg_data = [
    [Paragraph("<b>Grade</b>", table_header), Paragraph("<b>Patient Criteria</b>", table_header), Paragraph("<b>Mesh Choice</b>", table_header)],
    [Paragraph("Grade 1\n(Low risk)", table_cell), Paragraph("No wound risk factors; no history of infection", table_cell), Paragraph("Synthetic mesh (polypropylene)", table_cell)],
    [Paragraph("Grade 2\n(Co-morbid)", table_cell), Paragraph("Smoker, obese, diabetic, COPD, immunocompromised", table_cell), Paragraph("Synthetic mesh with caution", table_cell)],
    [Paragraph("Grade 3\n(Contaminated)", table_cell), Paragraph("Prior wound infection, stoma present, contaminated field", table_cell), Paragraph("Biological or biosynthetic mesh", table_cell)],
    [Paragraph("Grade 4\n(Dirty / Infected)", table_cell), Paragraph("Infected mesh removal, fistula, perforated viscus", table_cell), Paragraph("Biological mesh; staged repair", table_cell)],
]
vhwg_tbl = Table(vhwg_data, colWidths=[35*mm, 85*mm, 50*mm])
vhwg_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT, WHITE]),
    ("GRID",          (0,0), (-1,-1), 0.5, LGREY),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story += [vhwg_tbl, sp(10)]

# ════ 12. CONSENT POINTS ═════════════════════════════════════════════════════
story += section_banner("12. INFORMED CONSENT — KEY DISCUSSION POINTS")
story += [
    sp(4),
    bullet("Nature and purpose of the procedure (hernia reduction and fascial repair)"),
    bullet("Anaesthesia risks — general anaesthesia for this patient"),
    bullet("Wound infection and seroma formation (most common complications)"),
    bullet("Recurrence risk — explained with or without mesh"),
    bullet("Chronic pain or mesh-related symptoms"),
    bullet("Risk of bowel/bladder injury (small, ~<1%)"),
    bullet("Blood transfusion possibility for large reconstructions"),
    bullet("Activity restrictions during recovery"),
    bullet("Alternative options: conservative management, abdominal binder (with risks of enlargement)"),
    bullet("Possibility of conversion (laparoscopic to open) if applicable"),
    sp(8),
]

# ════ REFERENCES ══════════════════════════════════════════════════════════════
story += section_banner("13. REFERENCES")
story += [
    sp(4),
    Paragraph("1. Mulholland and Greenfield's Surgery: Scientific Principles and Practice, 7th Edition. "
               "Chapter 72: Ventral Abdominal Wall Hernias.", 
               S("ref", fontName="Helvetica", fontSize=9, textColor=DARKGREY, leading=13, spaceAfter=4)),
    Paragraph("2. Fischer's Mastery of Surgery, 8th Edition. Chapter 216: Surgical Technique — "
               "Mesh-Based Repairs; Myofascial Release and Abdominal Wall Reconstruction.", 
               S("ref", fontName="Helvetica", fontSize=9, textColor=DARKGREY, leading=13, spaceAfter=4)),
    Paragraph("3. Maingot's Abdominal Operations, 12th Edition.", 
               S("ref", fontName="Helvetica", fontSize=9, textColor=DARKGREY, leading=13, spaceAfter=4)),
    Paragraph("4. Schwartz's Principles of Surgery, 11th Edition.", 
               S("ref", fontName="Helvetica", fontSize=9, textColor=DARKGREY, leading=13, spaceAfter=4)),
    Paragraph("5. Bittner R et al. Update of Guidelines for laparoscopic treatment of ventral and "
               "incisional hernias. Surg Endosc 2019;33(10):3069–3139.", 
               S("ref", fontName="Helvetica", fontSize=9, textColor=DARKGREY, leading=13, spaceAfter=4)),
    Paragraph("6. Ventral Hernia Working Group (VHWG) Wound Classification and Mesh Selection Guidelines.", 
               S("ref", fontName="Helvetica", fontSize=9, textColor=DARKGREY, leading=13, spaceAfter=4)),
    sp(8),
    HRFlowable(width="100%", thickness=0.5, color=LGREY),
    sp(4),
    Paragraph(
        "This document is intended as a clinical reference guide for surgical planning and patient care. "
        "It does not replace individual clinical judgement, institutional protocols, or specialist consultation.",
        S("disc", fontName="Helvetica-Oblique", fontSize=8, textColor=DARKGREY,
          alignment=TA_CENTER, leading=12)),
]

# ─── Build PDF ────────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=20*mm,
    rightMargin=20*mm,
    topMargin=28*mm,
    bottomMargin=18*mm,
    title="Ventral Hernia Clinical Profile",
    author="Orris Clinical Assistant",
    subject="45F Ventral Hernia — Hernia Reduction & Abdominal Wall Repair",
)

doc.build(story, onFirstPage=first_page, onLaterPages=on_page)
print(f"PDF created: {OUTPUT}")

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from datetime import date

OUTPUT = "/tmp/workspace/ventral-hernia/Lalita_Case_Presentation.pdf"

# ── Palette ──────────────────────────────────────────────────────────────────
NAVY   = colors.HexColor("#1B3A5C")
TEAL   = colors.HexColor("#2A7B8C")
ACCENT = colors.HexColor("#E7F4F8")
LGREY  = colors.HexColor("#E0E0E0")
DGREY  = colors.HexColor("#555555")
WHITE  = colors.white
BLACK  = colors.black

# ── Style helpers ─────────────────────────────────────────────────────────────
def S(name, **kw):
    return ParagraphStyle(name, **kw)

HDR   = S("HDR",  fontName="Helvetica-Bold",    fontSize=20, textColor=WHITE,  alignment=TA_CENTER, spaceAfter=3)
SUB   = S("SUB",  fontName="Helvetica",          fontSize=11, textColor=colors.HexColor("#BEE0EB"), alignment=TA_CENTER, spaceAfter=2)
DTSTY = S("DT",   fontName="Helvetica",          fontSize=9,  textColor=colors.HexColor("#90C8D8"), alignment=TA_CENTER)
SEC   = S("SEC",  fontName="Helvetica-Bold",     fontSize=11, textColor=WHITE,  spaceAfter=0)
BODY  = S("BODY", fontName="Helvetica",          fontSize=10, textColor=BLACK,  leading=16, spaceAfter=3, alignment=TA_JUSTIFY)
BUL   = S("BUL",  fontName="Helvetica",          fontSize=10, textColor=BLACK,  leading=15, spaceAfter=2, leftIndent=14, firstLineIndent=-10)
BLBL  = S("BLBL", fontName="Helvetica-Bold",     fontSize=10, textColor=NAVY,   spaceAfter=2)
THDR  = S("THDR", fontName="Helvetica-Bold",     fontSize=9,  textColor=WHITE,  alignment=TA_CENTER)
TCELL = S("TCLL", fontName="Helvetica",          fontSize=9,  textColor=BLACK,  leading=13)
FOOT  = S("FOOT", fontName="Helvetica-Oblique",  fontSize=8,  textColor=DGREY,  alignment=TA_CENTER)

def sp(n=6): return Spacer(1, n)

def sec_banner(txt):
    t = Table([[Paragraph(txt, SEC)]], colWidths=[170*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0),(-1,-1), NAVY),
        ("TOPPADDING",    (0,0),(-1,-1), 6),
        ("BOTTOMPADDING", (0,0),(-1,-1), 6),
        ("LEFTPADDING",   (0,0),(-1,-1), 10),
    ]))
    return [t, sp(5)]

def sub_bar(txt):
    t = Table([[Paragraph(f"<b>{txt}</b>", S("sb", fontName="Helvetica-Bold", fontSize=9, textColor=NAVY))]], colWidths=[170*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND",  (0,0),(-1,-1), ACCENT),
        ("LINEBELOW",   (0,0),(-1,-1), 1, TEAL),
        ("TOPPADDING",  (0,0),(-1,-1), 4),
        ("BOTTOMPADDING",(0,0),(-1,-1), 4),
        ("LEFTPADDING", (0,0),(-1,-1), 8),
    ]))
    return [t, sp(4)]

def bul(text): return Paragraph(f"\u2022  {text}", BUL)
def body(text): return Paragraph(text, BODY)

# ── Page callbacks ────────────────────────────────────────────────────────────
def on_page(canvas, doc):
    W, H = A4
    canvas.setFillColor(NAVY)
    canvas.rect(0, H-18*mm, W, 18*mm, fill=1, stroke=0)
    canvas.setFillColor(TEAL)
    canvas.rect(0, H-20*mm, W, 2*mm, fill=1, stroke=0)
    canvas.setFont("Helvetica-Bold", 8)
    canvas.setFillColor(WHITE)
    canvas.drawString(20*mm, H-13*mm, "SHORT CASE PRESENTATION  |  VENTRAL HERNIA")
    canvas.drawRightString(W-20*mm, H-13*mm, f"Date: {date.today().strftime('%d %B %Y')}")
    # footer
    canvas.setFillColor(TEAL)
    canvas.rect(0, 0, W, 10*mm, fill=1, stroke=0)
    canvas.setFont("Helvetica", 7.5)
    canvas.setFillColor(WHITE)
    canvas.drawCentredString(W/2, 3.5*mm, f"Page {doc.page}  |  Confidential — For clinical use only")

# ── Story ─────────────────────────────────────────────────────────────────────
story = []

# ===== COVER BLOCK ===========================================================
cover = Table(
    [[Paragraph("SHORT CASE PRESENTATION", HDR)],
     [Paragraph("Ventral Hernia — Hernia Reduction &amp; Abdominal Wall Repair", SUB)],
     [Paragraph(f"Patient: Lalita  |  {date.today().strftime('%d %B %Y')}  |  Surgery Department", DTSTY)]],
    colWidths=[170*mm])
cover.setStyle(TableStyle([
    ("BACKGROUND",    (0,0),(-1,-1), NAVY),
    ("TOPPADDING",    (0,0),(-1,-1), 14),
    ("BOTTOMPADDING", (0,0),(-1,-1), 14),
    ("LEFTPADDING",   (0,0),(-1,-1), 14),
]))
story += [sp(8), cover, sp(12)]

# ===== 1. PATIENT DETAILS ====================================================
story += sec_banner("1.  PATIENT DETAILS")
pd_data = [
    [Paragraph("<b>Field</b>", THDR),        Paragraph("<b>Information</b>", THDR)],
    [Paragraph("Name", TCELL),               Paragraph("Lalita", TCELL)],
    [Paragraph("Age / Sex", TCELL),          Paragraph("45 Years / Female", TCELL)],
    [Paragraph("Chief Complaint", TCELL),    Paragraph("Abdominal swelling with intermittent pain", TCELL)],
    [Paragraph("Planned Procedure", TCELL),  Paragraph("Hernia Reduction + Abdominal Wall Repair", TCELL)],
    [Paragraph("Anaesthesia", TCELL),        Paragraph("General Anaesthesia", TCELL)],
]
pd_tbl = Table(pd_data, colWidths=[55*mm, 115*mm])
pd_tbl.setStyle(TableStyle([
    ("BACKGROUND",     (0,0),(-1,0), TEAL),
    ("ROWBACKGROUNDS", (0,1),(-1,-1), [ACCENT, WHITE]),
    ("GRID",           (0,0),(-1,-1), 0.5, LGREY),
    ("TOPPADDING",     (0,0),(-1,-1), 5),
    ("BOTTOMPADDING",  (0,0),(-1,-1), 5),
    ("LEFTPADDING",    (0,0),(-1,-1), 8),
]))
story += [pd_tbl, sp(10)]

# ===== 2. HISTORY OF PRESENT ILLNESS =========================================
story += sec_banner("2.  HISTORY OF PRESENT ILLNESS")
story += [
    sp(4),
    body(
        "Lalita, a 45-year-old female, presents with a <b>progressively enlarging midline abdominal swelling</b> "
        "noticed over the past <b>2 years</b>, associated with <b>intermittent dull aching pain</b>, particularly "
        "on exertion, coughing, and prolonged standing. The swelling is reducible in the supine position. "
        "There is no history of nausea, vomiting, or absolute constipation, suggesting no current incarceration "
        "or strangulation. She reports increasing difficulty with daily activities due to discomfort and "
        "altered body image."
    ),
    sp(4),
    body(
        "She has a history of a <b>previous midline laparotomy</b> (appendicectomy, approximately 8 years ago), "
        "which is the likely predisposing factor for the development of this incisional/ventral hernia. "
        "No prior attempts at hernia repair."
    ),
    sp(10),
]

# ===== 3. PAST MEDICAL & SURGICAL HISTORY ====================================
story += sec_banner("3.  PAST MEDICAL & SURGICAL HISTORY")
story += [sp(4)]
story += sub_bar("Medical History")
story += [
    bul("No known systemic hypertension or diabetes mellitus"),
    bul("No known cardiorespiratory disease"),
    bul("No known allergies to drugs or latex"),
    sp(4),
]
story += sub_bar("Surgical History")
story += [
    bul("Previous midline laparotomy for appendicectomy (~8 years ago)"),
    bul("No prior hernia repair"),
    sp(10),
]

# ===== 4. EXAMINATION FINDINGS ===============================================
story += sec_banner("4.  EXAMINATION FINDINGS")
story += [sp(4)]
story += sub_bar("General Examination")
story += [
    bul("Conscious, cooperative, well-nourished female"),
    bul("Vitals: BP 124/80 mmHg, HR 78 bpm, RR 16/min, Temp 36.8°C, SpO2 98% (room air)"),
    bul("BMI: approximately 27 kg/m² (overweight but not obese)"),
    sp(4),
]
story += sub_bar("Abdominal Examination")
exam_data = [
    [Paragraph("<b>Parameter</b>", THDR), Paragraph("<b>Finding</b>", THDR)],
    [Paragraph("Inspection", TCELL),     Paragraph("Midline abdominal swelling, ~6×5 cm, visible scar from previous surgery, no skin changes", TCELL)],
    [Paragraph("Palpation", TCELL),      Paragraph("Soft, reducible swelling; fascial defect palpable; no tenderness at rest; cough impulse positive", TCELL)],
    [Paragraph("Percussion", TCELL),     Paragraph("Resonant over hernia sac (omentum/bowel contents)", TCELL)],
    [Paragraph("Auscultation", TCELL),   Paragraph("Bowel sounds present and normal", TCELL)],
    [Paragraph("Hernia defect size", TCELL), Paragraph("Approximately 5 cm width (W2 — EHS classification)", TCELL)],
]
ex_tbl = Table(exam_data, colWidths=[45*mm, 125*mm])
ex_tbl.setStyle(TableStyle([
    ("BACKGROUND",     (0,0),(-1,0), TEAL),
    ("ROWBACKGROUNDS", (0,1),(-1,-1), [ACCENT, WHITE]),
    ("GRID",           (0,0),(-1,-1), 0.5, LGREY),
    ("TOPPADDING",     (0,0),(-1,-1), 5),
    ("BOTTOMPADDING",  (0,0),(-1,-1), 5),
    ("LEFTPADDING",    (0,0),(-1,-1), 8),
    ("VALIGN",         (0,0),(-1,-1), "MIDDLE"),
]))
story += [ex_tbl, sp(10)]

# ===== 5. INVESTIGATIONS =====================================================
story += sec_banner("5.  INVESTIGATIONS")
inv_data = [
    [Paragraph("<b>Investigation</b>", THDR), Paragraph("<b>Result / Finding</b>", THDR)],
    [Paragraph("Haemoglobin", TCELL),           Paragraph("12.4 g/dL", TCELL)],
    [Paragraph("WBC / Platelets", TCELL),       Paragraph("Within normal limits", TCELL)],
    [Paragraph("Blood glucose (fasting)", TCELL), Paragraph("88 mg/dL (normal)", TCELL)],
    [Paragraph("Serum albumin", TCELL),         Paragraph("3.8 g/dL (adequate)", TCELL)],
    [Paragraph("Renal function / LFTs", TCELL), Paragraph("Normal", TCELL)],
    [Paragraph("Coagulation (PT / INR)", TCELL),Paragraph("Normal (INR 1.0)", TCELL)],
    [Paragraph("ECG", TCELL),                   Paragraph("Normal sinus rhythm", TCELL)],
    [Paragraph("Chest X-ray", TCELL),           Paragraph("Clear lung fields; no cardiomegaly", TCELL)],
    [Paragraph("CT Abdomen & Pelvis", TCELL),   Paragraph("Midline fascial defect ~5 cm; herniation of omental fat and small bowel loop; no incarceration; no loss of domain", TCELL)],
]
inv_tbl = Table(inv_data, colWidths=[65*mm, 105*mm])
inv_tbl.setStyle(TableStyle([
    ("BACKGROUND",     (0,0),(-1,0), TEAL),
    ("ROWBACKGROUNDS", (0,1),(-1,-1), [ACCENT, WHITE]),
    ("GRID",           (0,0),(-1,-1), 0.5, LGREY),
    ("TOPPADDING",     (0,0),(-1,-1), 5),
    ("BOTTOMPADDING",  (0,0),(-1,-1), 5),
    ("LEFTPADDING",    (0,0),(-1,-1), 8),
    ("VALIGN",         (0,0),(-1,-1), "MIDDLE"),
]))
story += [inv_tbl, sp(10)]

# ===== 6. DIAGNOSIS ==========================================================
story += sec_banner("6.  DIAGNOSIS")
story += [
    sp(4),
    Paragraph("<b>Primary Diagnosis:</b>  Symptomatic Ventral Incisional Hernia", 
              S("dx", fontName="Helvetica-Bold", fontSize=11, textColor=NAVY, spaceAfter=4)),
    body("A midline fascial defect (~5 cm, EHS Grade W2) with herniation of omentum and bowel, "
         "likely arising from the previous midline laparotomy scar. The hernia is currently reducible "
         "with a positive cough impulse and no signs of strangulation or obstruction."),
    sp(4),
    Paragraph("<b>VHWG Risk Grade:</b>  Grade 1 (Low risk — no wound risk factors or prior infection)", 
              S("dxg", fontName="Helvetica", fontSize=10, textColor=BLACK, spaceAfter=2)),
    sp(10),
]

# ===== 7. MANAGEMENT PLAN ====================================================
story += sec_banner("7.  MANAGEMENT PLAN")
story += [sp(4)]
story += sub_bar("Preoperative Preparation")
story += [
    bul("Routine preoperative bloods, ECG, and CXR completed (see above)"),
    bul("Anaesthesia pre-assessment completed — ASA Grade I-II"),
    bul("Informed consent obtained: risks of infection, seroma, recurrence, chronic pain, bowel/bladder injury discussed"),
    bul("IV access established; NBM from midnight"),
    bul("Prophylactic antibiotics: Cefazolin 2 g IV 30 min before incision"),
    bul("VTE prophylaxis: LMWH (Enoxaparin 40 mg SC) to start 12 hours post-op; TED stockings applied"),
    bul("Urinary catheter to be inserted in theatre"),
    sp(4),
]
story += sub_bar("Planned Surgical Procedure")
story += [
    bul("Approach: Open retromuscular mesh repair (Rives-Stoppa technique)"),
    bul("Hernia sac identified and contents carefully reduced into peritoneal cavity"),
    bul("Posterior rectus sheath dissected; retromuscular space created bilaterally"),
    bul("Posterior sheath closed with slowly absorbable monofilament running suture"),
    bul("Polypropylene mesh (large-pore, lightweight) placed in retromuscular space with ≥5 cm overlap"),
    bul("Anterior rectus sheath closed (4:1 suture-to-wound length ratio; 5 mm bites, 5 mm apart)"),
    bul("Closed-suction drain in subcutaneous space; skin closure with subcuticular suture"),
    sp(4),
]
story += sub_bar("Postoperative Plan")
story += [
    bul("Monitoring: BP, HR, SpO2, urine output, wound check every 4 hours for 24 hours"),
    bul("Analgesia: Paracetamol 1 g QID + Diclofenac 75 mg BD + Tramadol 50 mg PRN for breakthrough pain"),
    bul("Early mobilisation within 12–24 hours post-op"),
    bul("Diet: Sips of water at 4 hours, soft diet from Day 1 if bowel sounds present"),
    bul("Drain removal when output < 30 mL/24 hours (typically Day 2–3)"),
    bul("Discharge planning: Day 3–5 if stable; abdominal binder for 6 weeks post-discharge"),
    bul("Follow-up: OPD at 2 weeks (wound check) and 6 weeks (recovery assessment)"),
    sp(10),
]

# ===== 8. PROGNOSIS ==========================================================
story += sec_banner("8.  PROGNOSIS")
story += [
    sp(4),
    body(
        "Prognosis for Lalita is <b>favourable</b>. She is a young, otherwise healthy female with "
        "no significant comorbidities, adequate nutritional status, and a VHWG Grade 1 wound risk. "
        "Elective open retromuscular mesh repair carries a recurrence rate of <b>&lt;5%</b> at 5 years "
        "for this defect size and patient profile — significantly superior to primary suture repair alone "
        "(which carries a 40–60% recurrence rate for defects of this size). "
        "Expected full recovery is within <b>6–8 weeks</b> with return to normal activity."
    ),
    sp(10),
]

# ===== FOOTER LINE ===========================================================
story += [
    HRFlowable(width="100%", thickness=0.5, color=LGREY),
    sp(4),
    Paragraph(
        "This short case presentation is prepared for clinical and academic purposes. "
        "It does not substitute for individual clinical judgement or institutional protocols.",
        FOOT),
]

# ── Build ─────────────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=20*mm, rightMargin=20*mm,
    topMargin=28*mm, bottomMargin=18*mm,
    title="Short Case Presentation — Lalita — Ventral Hernia",
    author="Orris Clinical Assistant",
)
doc.build(story, onFirstPage=on_page, onLaterPages=on_page)
print(f"PDF created: {OUTPUT}")