The objective of surgery is to help the patient. The surgeon wants to repair the injury but at the same time To Do No Harm. To help me achieve these goals I follow the following rules during hernia surgery.
- Handle the tissues delicately and with care.
- Minimize the use of the cautery. The heat and current can damage remote tissues.
- Minimize the dissection of the spermatic cord.
- Use absorbable sutures as much as possible.
- Do not place sutures in the region of the pubic tubercle or near the medial
attachment of the inguinal ligament.
- When repairing the inguinal floor, avoid placing sutures in the internal oblique
muscle. The iliohypogastric nerve sometimes courses through this muscle. Use
the transversalis for the repair.
- Handle the nerves little as possible.
- Know where the nerves are.
- If neurectomy is required, excise the nerve distally and bury the nerve proximally.
- Have plans to do with any unforeseen problems.
- Be sure the patient understands the procedure and has reasonable expectations