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!)