Like learning to ride a bike.

Today feels like another landmark in the mesh hernia work. The first case of the day was a pretty straight forward inguinal hernia repair and I informed the two local surgeons that I would not be scrubbing. It felt a little bit like the moment when you first take the stabilisers off your child’s bike hold their saddle to get them going then let go! It is a moment of deep pride mixed with inevitable anxiety. I sat on a stool in theatre watching them work together, resisting the urge to look too much or make ‘helpful’ suggestions. But I made plenty of encouraging noises when required. They needed a little bit of advice here and there and some gentle reminders about the details of some of the steps. But they did brilliantly. Until they ‘fell off’. Whilst skeletalising the cord (the life line to the testis), they had been a little overzealous and had caused one of the cord vessels to bleed. Their efforts to correct this was making things worse and there comes a point when the only ‘right’ thing to do is to intervene. I dutifully scrubbed, took control, explained the problem and demonstrated what I would do, whilst making it clear that the best strategy is to avoid being in this position at all. Fortunately, the cord was salvaged (which means the lifeline to the testicle remained functioning adequately) and the end result was a good learning experience. Having helped them ‘back up’, ‘brushed off their knees’ and got them going again, I once more ‘let go of the saddle’. And off they went. A wobble here and there but they finished the repair without further intervention and I must say that the end technical result was very pleasing.

Almost as reward for my efforts with the first case in the morning, they had booked the repair of a re-recurrent hernia as last case of the day for me. This means that it had been repaired twice before and failed. It was always going to be difficult and indeed it was. With the normal anatomy completely disrupted, it was quite remarkable that we managed to make any sense of it at all. However, we managed to find the spermatic cord, preserve it, carve out and suture together something to reconstruct a vague resemblance to what it should look like, as well as finding somewhere suitable to locate the mesh. In the end it came together well, but I couldn’t help myself from thinking about the laparoscopic approach we would have used in the UK in such a scenario. However, with a mesh now in situ, hopefully this will be the final time he needs this hernia repairing….

So another long, but good, day ‘in the saddle’.