It Would Be Nice everyone’s body was exactly the same on the inside. That way it a surgeon would always know where important structures were located and therefore during surgery, these vital structures could be quickly identified and protected. But the human body makes its own decisions and does not always follow the rules found in the anatomy books.
During hernia repairs, the nerves are the structure most commonly in the “wrong place”.
In the anatomy books, the genital nerve usually is on the posterior aspect of the cord, but it can be found on the floor of the inguinal canal or along the inguinal ligament. The Ilioinguinal nerve usually runs on the anterior aspect of the spermatic cord, but it can run along the internal oblique muscle. The iliohypogastric nerve usually runs along the anterior aspect of the internal oblique muscle, but it can be found traveling within the…
There is a sign in my Auto Mechanic’s shop that says:
“I Cheat the Other Guy and Pass the Savings on to You.”
I smile every time I read the sign. But in a way, this message also applies to surgeons.
No one is perfect (except for my daughter) and during every operation, the surgeon should think, “Could I have done that operation a little bit better?” A good surgeon will then incorporate those improvements into the next operation.
To update my mechanic’s sign:
“I learned from the operation on the previous patient and pass that experience on to You.”
Please do not hesitate to contact me about your sports hernia or your classic hernia.
Bill Brown, M.D.
Do Older Surgeons have Better Results than Younger Surgeons?
The last time I flew, the pilot was a 60 plus year old man with gray hair. It made me think, do I want and old and experienced pilot or would it be better and safer to have a young pilot. After all, my life was in his hands.
I ask myself that question all the time. Am I still mentally and physically capable to provide excellent care to my patients. Every time I examine a patient or perform an operation I ask myself is there a way that I can do this better. I truly believe that I am better surgeon now than when I first graduated.
Below is an article that compares the results of operations performed by young surgeons and older surgeons. I am glad to say that the gray haired surgeons had better results. Old and experienced…
Is Bruising Dangerous?
After surgery there is always some blood left behind no matter how carefully the operation was performed. Sometimes this blood will slowly work its way up to the surface and form a bruise. A bruise is simply blood in the skin and it can be very colorful, but it is not dangerous. Also remember that blood is a liquid and it sometimes runs downhill. What that means is that even though the operation was in the inguinal area, it is not uncommon to see a bruise in the scrotum and penis or the vulva after surgery. Initially the bruise will be dark blue or purple. As the body breaks down and reabsorbs the blood the bruise will develop shades of green and then in a few more days you will see shades of brown and yellow.
If you think you may have an inguinal hernia and want…
After any operation the body goes through three stages healing.
Inflammatory Stage: During this stage the white blood cells move into the incision to remove injured cells, bacteria, and debris. This stage can be minimized by the surgeon with gentle handling of the tissues and careful hemostasis.
Proliferation Stage: During this stage fibroblasts move into the area to lay down collagen and fibronectin. The strands of collagen provides the strength of the repair. The fibronectin binds the collagen strands together. Because of the collagen deposition, on about day 5 you will feel what is called the “Healing Ridge” under the incision. This will be firm and mildly painful ridge of tissue. It will extend beyond the incision for about 2cm. Myofibroblasts will then move into the area. These cells contain muscle fibers and will contract to pull everything together. This will make the operative area will feel very tight. The…
Post Operative Pain Control
You have decided to your inguinal hernia or your sports hernia repaired, but you are worried about having pain after surgery. Luckily by understanding the innervation of the region, pain control after surgery has vastly improved. The ilioinguinal and the iliohypogastric nerves provide sensation to the inguinal region. These nerves start at L1 and L2 and then travel to the inguinal region between oblique muscles. Local anesthetics can be used to block the nerves and thereby minimize postoperative pain.
Types of Nerve Blocks
- TAP Block (transversus abdominis plane). Using an ultrasound machine the ilioinguinal and the iliohypogastric nerves are visualized between the transversalis muscle and the internal oblique muscle. Then a needle is used to inject local anesthetic around the nerves.
- The ilioinguinal and an iliohypogastric nerves can also be blocked at the anterior superior iliac spine. At this site the nerves travel between oblique muscles.…