Page 49 - herina surgery and possible lawsuits

• Superficially, subcutaneous hematoma or severe ecchymosis can result from vessels

i.e., external pudendal, circumflex iliac, and superficial epigastric.
• On a deeper plane, during resection of the cremaster the external spermatic artery can
result in a tense hematoma and ecchymosis that extend to the scrotum.

• At the time of division of the transversahs fascia, deep inferior epigastric vessels (one
artery, two veins) can be divided particularly during recurrent hernia surgery.

• Within the space of Bogros, a venous circulation is present which may be the source
of brisk bleeding i.e., iliopubic vein, rectusial vem, and less commonly an iliopubic
artery is present.

• The presence of an aberrant obturator artery originating from the deep inferior
epigastric artery can be the source of bleedmg when blind sutures are inserted m the
ligament of Cooper without splitting the transversalis fascia or when the lacunar

ligament is incised from below the inguinal ligament while an attempt is made to free
an incarcerated femoral hernia. This dangerous step must be fraught upon and has
earned the artery the unenviable designation of "artery of death."

• Injuries to the femoral vein may be caused by suture of the anterior wall of the vem
during inclusion of the shelving edge of Poupart's ligament in the repair or by
compression of the femoral vem by a suture that is placed too laterally on the

ligament of Cooper
• A minor but not uncommon complication is thrombophlebitis of the dorsal vein of the
perns, with an mcidence of 0.65%

Associatedfactors
Associated conditions has no direct relation with hernia but were present as cofactor or
etiological factors. Associated factors also play role m selection of anesthesia.

• At Shouldice Hospital, the study of 7159 patients revealed that 52.1% of all patients
were more than 50 years of age. Associated cardiovascular factors recorded on these
patients were anticoagulation therapy (aspirin, ticlopidine, warfarin 12%), history of

myocardial infarction (15%), history of angina (15%), therapy for congestive heart
failure (17%), hypertension (20%), and cardiac arrhythmias (50%).[6]
• In one study, the factors were hypertension (55%), IHD (2%), COPD (9.1%), DM

(9.2%), Prostatism (21.4%), Cigarette smoking (37%) and alcohol (24.1%) of the
patients.[53]

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