I Am a Bicycle Tire Tube


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!)