Laparoscopic or Open Approach

I’ve mentioned these before in these posts, and I hope this discussion board can be a tool to spread this information to others, including your physicians:

1. If you have a bulge on exam already, then imaging is not necessary. You have a diagnosis. Imaging rarely offers anything more than confuse the sutuation, such a as the radiologist saying it’s negative.

2. If a CT scan is negative for a hernia, and there is clinical evidence for a hernia (suggestive by story and by exam), then either a) the CT scan is misinterpreted (commonly), or b) you must seek a more sensitive test, such as MRI. In JAMA Surgery, my paper will be out soon that discusses the different imaging modalities and their use to determine hernias.

3. Laparoscopic surgery should only be performed by a specialist who has at least 250 (and some say 500-750) laparoscopic inguinal hernias in their experience. Otherwise, the recurrence rate and complications may be too high. So, do not choose laparoscopic surgery just because It sounds better; in some cases and with most surgeons, open repair is safer and with better outcomes.

4. If no hernia is found, do not undergo hernia repair or mesh placement. You cannot become better. And you may be subjecting yourself to risks. (Perhaps you misunderstood your surgeon: if on one side a hernia is noted, mesh is always placed to cover that hernia and those around it on the same side. That is standard.)

5. If you have a hernia and hernia-related pain, then repair will cure you. In women, the hernia may be small and the findings minimal. However, the associated pain may be severe and repair will help you. Most do not yet appreciate this among women.