The Sports Hernia Operation
Each Athlete has an operation tailored to his/her needs and injury. The following describes the major points of a typical operation.
In the preoperative area, I reexamine the patient and answer any last-minute questions. The nurse then moves the Athlete to the operative suite. Anesthesia consists of a nerve block and sedation. Though if requested, general anesthesia is an option.
- 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. If necessary, this tear is extended superiorly and laterally to the level of the internal ring. The spermatic cord (the round ligament in women) is just deep to the external oblique. 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.
- The spermatic cord is explored. If there is an indirect inguinal hernia sac present, then this is separated from the cord, and a high ligation is performed.
- Using the Penrose drain, the spermatic cord is retracted inferiorly out of the operative field. The inguinal floor can then be inspected. The floor of the inguinal canal is usually thin and torn.
- The inguinal floor is reconstructed by suturing the aponeurosis of transversus abdominis muscle to Poupart’s ligament using interrupted sutures. The sutures dissolve with time. Any redundancy of the internal inguinal ring is repaired. The conjoined tendon is reconstructed at the same time.
- Next, the inferior leaf of the external oblique fascia and the superior left of the external oblique are overlapped. The imbrication completely closes the external inguinal ring at its usual position. This closure reinforces this region and decreases the recurrence rate.
- The spermatic cord is left in the subcutaneous tissues.
- The subcutaneous fascia and skin are closed with absorbable sutures.
Contact Dr. Brown to learn more and to discuss your injury.