The Sports Hernia Operation
Dr. Brown uses a modified Bassini repair for his patients. In the preoperative area, the operative site is reexamined and is marked and initialed. Any last minute questions are answered. In the operative suite the patient is then placed in a supine position and operative site is prepped and draped. The usual anesthesia is local anesthetic with sedation.
- A skin crease incision is made between the internal and external inguinal rings.
- The subcutaneous tissues are divided.
- The superficial epigastric vein is ligated if necessary.
- The external oblique fascia is identified and followed inferiorly and medially to the external inguinal ring.
- The external oblique is usually torn and separated along its fibers starting at the superior lateral border of the external ring. This tear is extended (if necessary) and flaps of the external oblique fascia are raised superiorly and inferiorly. The exposes the spermatic cord (the round ligament in women). The spermatic cord is circumferentially dissected free at the level of the pubis. A Penrose drain is looped around the spermatic cord. The spermatic cord is then freed back to the level of the internal inguinal ring. If a decision has been made to perform a neurectomy, the ilioinguinal nerve is transected and the stump is buried in the muscle. The distal portion of the nerve and its branches are excised.
- The spermatic cord is explored. If there is an indirect inguinal hernia sac present, then this is explored and a high ligation is performed. Any major lipomas are also removed.
- Using the Penrose drain, the spermatic cord is retracted inferiorly out of the operative field. This exposes the floor of the inguinal canal. Characteristically, the floor of the inguinal canal will be thinned and the fibers partially disrupted starting at the conjoined tendon and extending towards the epigastric vessels.
- The floor of the inguinal canal is reconstructed by suturing the aponeurosis of transversus abdominis muscle to Poupart’s ligament using interrupted sutures. Any redundancy of the internal inguinal ring is repaired. The conjoined tendon is reconstructed at the same time.
- Next the external oblique fascia is closed in a vest over a pants manner. This completely closes the external inguinal ring at its usual position. This is important, because the external inguinal ring is the most common site of injury in patients with sports hernias. This complete closure of the external inguinal ring reinforces this region and prevents future injuries.
- The spermatic cord is left in the subcutaneous tissues similar to a Halsted Repair.
- The subcutaneous fascia and skin are closed with absorbable sutures.