Dr. Azim Khan Operates a Big Inguinal Hernia

Today, in operation theater (Nishtar Hospital Multan), Dr. Azim Khan (SR) operated a big inguinal hernia. The operation was assisted by Dr. Khalid (PGR), Dr. Muzammil Irshad (H/S), Dr. Ali Akash Parhar (H/S) and Dr. Adeel Arshad (H/S). It was a male of 60 years old having a big left inguinal hernia. The hernia really looked like monstrous one. The patient had to bear this monstrous thing for one and half year. The operation had to be postponed two times because there was no one available to put hands on it (hernia). Today, Dr. Azim Khan went ahead and relieved the patient from such a burden. Of course, all the credit goes to Dr. Azim Khan (SR), a dexterous, disciplined and docile personality.

Operating Doctor's Team

On the operation table, supra-inguinal incision (above and parallel to the medial two third of inguinal ligament) was made, and along with two layers of superficial fascia (outer Camper’s fascia and inner Scarpa’s fascia), external oblique aponeurosis was incised. In order to expose the inguinal ligament, upper leaf was reflected above and lower one was reflected downward. Sac was opened by holding the peritoneum with two artery forceps. Our wonders had no bounds when we found it another small abdomen in the scrotum as the sac was containing a large portion of small gut, caecum, small portion of large gut and mesentery (sliding hernia). All these contents were reduced into the actual abdomen and the sac was closed using absorbable suture material (vicryl). Also, left sided orchidectomy was performed. Prolene Mesh was placed by suturing it with inguinal ligament below and the conjoined tendon above. Rectus sheath was closed by placing continuous sutures vicryl material. Abdominal skin was closed with silk suture and antiseptic dressing was done.

A Big Inguinal Hernia

A Big Inguinal Hernia

The patient was advised to be passed naso-gastric tube and be kept on “nil per oral” till further order. Along with one Ringer Lactate (1000 ml state), 5% Dextrose Water (1000 ml BD) was advised.  Also, antibiotics and scrotal support were advised by Dr. Azim Khan (SR).

Small gut with mesentry, caecum and a portion of large gut, the contents in the sac of inguinal hernia

Orchidectomy was performed after reducing the abdominal contents contained in the scrotum.

Dressing done after left hernioplasty and left orchidectomy

By: Dr. Muzammil Irshad (drmuzammilirshad@gmail.com)

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