You had your hernia repaired and you are on your way home from the surgery center. You are hot and sweaty from the car ride. Your skin is itchy from the betadine skin prep, and you are starting to smell. You have a box of baby wet wipes, but you really want a shower. Is it safe to get naked and jump in the shower?
After your surgery, the body immediately starts the healing process. After 12 hours, the skin is healed enough to prevent bacteria from entering through the incision. So 12 hours after your hernia repair feel free to take off the gauze and the tape and take a shower. Soap will not hurt the incision.
Afterward, you can leave the incision open to the air. If there is some drainage, put a fresh bandage on overnight.
Only one person in the shower with you until you feel…
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…
The inguinal ligament is a band of fibrous tissue that starts at the anterior superior iliac spine and runs inferiorly and medially to attach to the pubic bone at the pubic tubercle. The rectus femoris muscle attaches to the inferior aspect and the external oblique muscle forms the superior aspect. It is called a ligament, but functionally it more like a tendon in that it is an extension of the external oblique’s muscle attachment to the bone. The medial attachment of the inguinal ligament is often damaged in athletes with sports hernias. It is very important that this injury is identified because if missed the athlete will have persistent pain after surgery.
The athlete will report pain at the pubic tubercle that is aggravated by acceleration. There is maybe some pain at rest. Direct pressure over the pubic tubercle will reproduce the pain. Often the medial inguinal ligaments and the…
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…
Local anesthetics are best way to control pain after surgery. There are very few side effects and the pain often can be completely eliminated, not just covered up with pain pills. They work by blocking the signals that nerves send back to the brain.
Lidocaine is the most common of the local anesthetics. It has very rapid onset, but only lasts for a few hours. It is very safe medication as long as dose is kept less than 300mg. The most common serious complications are cardiac and central nervous system. This is great anesthetic for operations where there will be very little pain after the operation. For example, removing a skin lesion.
Ropivacaine and Bupivacaine
Ropivacaine and Bupivacaine last much longer than Lidocaine and thus are much more helpful in surgical patients. If injected into the tissues, they will work for about 8 hours. If injected around a nerve,…
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…