E.D., a 48-year-old married dock worker with three children, developed inguinal bulging and pain on exertion when he lifted heavy objects. An occupational health service advised a surgical referral. The surgeon diagnosed E.D. with bilateral direct inguinal hernias and suggested that he not delay surgery, although he was not at high risk for a strangulated hernia. E.D. asked the surgeon if he could also be sterilized at the same time. He was scheduled for bilateral inguinal herniorrhaphy and elective vasectomy.
During the herniorrhaphy procedure an oblique incision was made in each groin. The incision continued through the muscle layers by either resecting or splitting the muscle fibers. The spermatic vessels and vas deferens were identified, separated, and gently retracted. The spermatic cord was examined for an indirect hernia. Repair began with suturing the defect in the rectus abdominis muscles, transverse fascia, cremaster muscle, external oblique aponeurosis, and Scarpa fascia with heavy-gauge synthetic nonabsorbable suture material.
The vasectomy began with the identification of the vas deferens through the scrotal skin. An incision was made, and the vas was gently dissected and retracted through the opening. Each vas was clamped with a small hemostat, and a 1-cm length was resected. Both cut ends were coagulated with electrosurgery and tied independently with a fine-gauge absorbable suture material. The testicles were examined, and the scrotal incision was closed with an absorbable suture material.
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