I Am a Bicycle Tire Tube

operation.jpg I went in for surgery yesterday morning to repair a small umbilical hernia. Mildly graphic material follows. My belly button done did me wrong. Having only had a few minor surgeries before, the most recent about nine years ago, I was surprised by a number of changes in procedure, the kind of clinically tested improvements we all hope are going on behind the scenes, and we often doubt are. The operation itself was quite simple, and took under an hour. I received a mild general anesthetic, and a local was applied liberally to my belly. I don't even recall being asked to count backwards from five. The surgeon cut a small slit in my belly button and cleaned up protruding material. Then he took a small circle of polypropylene and stitched this with permanent stitches inside the muscle, a neat trick. This is relatively new: a few years ago, small umbilical hernias were merely stitched, but the recurrence rate was unacceptably high. I joked to my kids that I was being repaired like a bicycle tire tube: the doc would put a plastic patch on me and glue it on. And that was true: the incision was glued shut, and scarring, if any, will be invisible. In the future, we are all bicycle tubes.
But the two significant changes, one of which I experienced earlier this year with someone else going through surgery, were prophylaxis. First, at Swedish Medical Center it is standard practice to more or less politely demand that patients take two showers before surgery using chlorhexidine (one trade name is Hibiclens), one the night before and one the morning of, using a carefully described process. I had no fewer than five people along the path from consulting on surgery to the day of remind me and check that I had done so. I read through research on this, and found that sometimes dramatic reductions in microbial infections come about from this cheap and simple pre-hospital prep. As the RN handling intake at the hospital also noted, patients come from a variety of socioeconomic backgrounds, and have varying standards of hygiene. However, she said, even with a high degree of personal care, microbes lurk, and pre-op surgical cleaning by itself isn't nearly as effective. It appears the CDC started recommending this step just a few years ago, but clinical research for specific procedures showing its efficacy dates back over a decade. Second, I was given an antibiotic dose about an hour before surgery. This is apparently also now typical, and seemingly a few years old as a general recommendation from what I can tell from medical papers and online hospital procedures. A small dose before surgery is equivalent to a 24-hour course following surgery, with the advantage of using far less antibiotic. I was heartened by everything I learned before and during my outpatient surgery. You want to believe that professions learn and improve. In some medical experiences, notably dealing with obstetricians, there appears to be an unfortunate amount of oral history that is maintained despite clinical research, continuing education, and simple observation. There's so much to gained in reducing infection rates that clearly the good hospital where I had my surgery has invested in the top-to-bottom training that I was the beneficiary of. (I'm feeling fine, thank you!)



      1. I opted for the cybernetic stomach implants, which will automatically convert biofuels into starchy potato products.

        1. The nurse called it a hibs scrub, or something like that I think. Possibly was not what you were talking about in the article. The national health service here is great in many ways (without them I wouldn’t be here to type this). But they are a massive bureaucracy, with lots of inertia and resistance to change. So I think its likely they’ve not got into it yet. And I didn’t get any superglue action either, which is a shame :(

  1. Can we watch you digest your food through the polypropyline window?

    On a more serious note, what prompted the surgery? Was it cosmetic, or was it causing you problems?

    1. Not cosmetic! This isn’t umbilicoplasty, to make a prettier belly button. I had a protrusion, checked with my doctor, was sent to a surgeon, and scheduled the operation. It got worse over the four weeks between me spotting it for the first time, and the surgery.

      You can ignore hernias, but they don’t get better on their own.

  2. As you were posting the article, I was having a very similar operation – incisional hernia repair. Right next to my bellybutton, incision about 10cm long. I had this done in the Uk, and nobody even mentioned washing before hand. Though if I say it myself I was smelling wonderful!
    Having just asked the nurse about this, she told me they used to do this but stopped years ago, after finding it didn’t have much of an impact.
    No idea as to how accurate or up to date this is, but interesting anyway.
    As for me – should be allowed home today, and can escape from the hospital “food”….

    1. Having just asked the nurse about this, she told me they used to do this but stopped years ago, after finding it didn’t have much of an impact.

      Odd, as there are piles of studies from the last decade that describe from reasonable to extraordinary reductions in infection from patient pre-surgery washing. A specific regimen has to be followed. Nurses sometimes are big spreaders of oral tradition, just like doctors.

      1. I think one of the biggest things that helps is that a clorhexidine shower gets things out of your hair. It is mind-numbing how much we can carry around in our hair when we get home from work. I was my hair every single morning before i go to work, for good reason – drives me bonkers when I see on House that new doctor with her gorgeous long hair straightened to perfection… doesn’t it get in her way when she’s doing ANYTHING? ew ew ew.

  3. I was planning on having baseball cards inserted into my spokes, if you know what I mean….I hear it makes you feel younger.

    I went thourgh your surgery, twice. Obviously, the first failed (after 5 years) and the 2nd…well, lets just say I ended up in the emergency room. Keep an eye on it.
    Stay Inflated

  4. I recently had a bilateral inguinal hernia repaired, and the surgeon did the IV drip of antibiotic here in Virginia as well. Didn’t do the soap, but it was a laproscopic procedure. His only rule was to not shave in the incision area for a few days before…

    Seems to have done the trick – didn’t have any problems with infection afterwards.

  5. I had the same surgery earlier this year. I have never had a surgery before. But it wasn’t too bad. The next day at home I was feeling pretty good and looking forward to a few days off. It would give me a chance to get some writing done. But then it hit me in a quick sweaty wave. Before I knew it I was vomiting into the bath room sink. Having stitches in my belly I couldn’t kneel into the toilet. It was awful. Every time I hurled I imagined my repair stitches getting messed up.

    I spent the next 3 days vomiting. I picked up some freaking horrible 72 hour stomach flu at the hospital. Worse, my wife, who was meant to be taking care of me got it too.

    The problem with hospitals is that they are full of sick people.

    1. Sounds like they didn’t give you good post-op care, or enough drugs! I’m sorry to hear about it.

  6. i had knee surgery in June (my third), and i too noticed the crazy cleansing requests with the two “implements” wrapped in foil. i did as i was told, and no infections yet. :-)

    interesting article, you cyborg.

    one question: how would one go about seeing scar tissue on a naval (other than the stuff that’s already there)?

  7. You mentioned ‘especially obstetricians’ – i can understand this. I am a student midwife, and you simply would not BELIEVE how long it takes research in maternity to filter through to ground level. Consider this little story.

    We often have a little bit of trouble working out when babies pass urine – disposable nappies are so good at what they do that the first little trickles that indicate the system is, indeed, working can be nigh impossible to notice. As such, most paediatricians who check the babies physically and deem them fit for discharge generally accept this as they know when ladies go home they’re attended by a community midwife who will check up on this, and also they’ll have been fed quite a bit more by then, but every so often you get one who doesn’t really know and is going on hearsay. A few days ago, a paediatric registrar (ie, is training to be a consultant, so has already been training after medical school for at least 2 years) checked a baby, and came and got me and said ‘Did you put the cotton wool balls in the baby’s nappy?’ I responded of course not, I am well aware it’s an incredibly out of date practice and wouldn’t dream of it, it only makes parents MORE anxious and isn’t a good method of telling anyway, and she was satisfied with that.

    However, it did make me laugh, because a few months previously, an SHO (in the first two years after medical school) had been routinely telling parents to do this, and when I told her it was only going to make parents paranoid, she sniffed and told me it was ‘a good policy’. She was brand new straight into the system, and already she was using horrendously out of date practice! Gaah!

    I know it’s only a tiny story, but I feel it’s very much an analogy for much of what goes on…

  8. I had exactly the same surgery as you (including the polyprop support) about 18 months ago here in Australia. I also had the two washes with a hospital-provided pre-soaped sterile sponge and I just thought it was business as usual. I was supposed to go home that same afternoon, but because I’m quite resistant to anaesthesia, they had to put me further under than planned so they kept me in overnight for observation. After a week or two of standing up VERY carefully I was fully healed and back to normal.

    Plus, it was completely covered by my government-provided health care. I had to wait about 6 months after my initial specialist appointment for the surgery, but the hernia wasn’t causing me any major problems so I was happy to wait for it.

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