The first mesh goes in.

Today has been a hugely significant moment in my time here. We performed the first mesh hernia repair.

Last night, I prepared some meshes ready to sterilise and freed myself of all other responsibility today to concentrate on the job in hand. Whilst a very routine procedure for me to do in the UK, here there were lots of things that I needed to ensure were done correctly. Today needed to go well. So, from the morning meeting I went straight to the theatre CSSD and took personal responsibility for the sterilisation process. During the 40min it took to ‘cook’ I made use of the time by writing up a guide for the process. I am confident that with the new miniature autoclave and the expertise within the department, the process is easily reproducible and thus sustainable for the future (which is so important to my work here).

We planned to do two hernia cases today before a couple of others. With the meshes ‘cooked’, the first patient was taken into the operating theatre ready to start the ‘spinal’. This is a form of anaesthetic whereby the lower body is numbed by putting medicine into the spine (similar to the epidurals used for c-sections). This is their routine practice here and something they do very well. Unfortunately, as the patient was ‘hooked up’ to the monitoring, it transpired that his blood pressure was unacceptably high. We had picked up on his hypertension a few weeks ago and had started treatment, but unfortunately he had not taken his medicine for the last two days. The only safe thing to do was to postpone his surgery.

The first mesh goes in!

(I have up till now resisted posting anything 'gory')

Suitable consent obtained.

The second case however went ahead. The patient had a recurrent hernia, his previous suture repair having failed after 4 years. This, in many ways, is a very fitting way to start our mesh efforts here; assuming recovery is uncomplicated… which is of course never guaranteed (writing those last few words causes a momentary pang of anxiety)! And we certainly had to work hard for the case today. It was a large hernia, heavily scarred with very distorted anatomy from his previous repair and plenty of potential pitfalls. However, we took our time and whilst challenging (a very common word in these blogs) the end result was technically very pleasing. The mesh performed brilliantly and now all he has to do is heal and recover without complication….