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Encouraging percentages from Docs please!
gretarae – First of all, don’t worry. You are fine, and a small, asymptomatic incisional hernia has a low probability of becoming worse in a short period of time. Second, the best study with long term follow-up of incisional hernia repair with and without mesh shows a 63% recurrence rate for the suture group and a 32% recurrence rate for the mesh group. This study however has many flaws. And most importantly regarding all the statistics is to know that they do not predict what will happen to you, because you are not a statistic, but an individual. The options are many, with relative risks and benefits of each option. By applying the following algorithm, you and your surgeon will make the best decision for you. You as an individual. Not for your hernia. 1. Identify what your goals are 2. Apply the clinical scenario related to your medical history 3. Apply the details of your hernia – location, size, position of rectus muscles (seen on ct scan) 4. Choose a technique (there are many) that fits your clinical scenario, hernia details, and is likely to meet your goals. 5. Choose a mesh (if using mesh) that is most appropriate for that technique. There are many choices here as well. 6. Have a plan B.
Very few surgeons know enough about the prosthetic choices, and have limited knowledge in their practice for the variety of techniques available. In my repair of hundreds of recurrent hernias, I have also seen many occasions where the surgeon and patient goals were not necessarily aligned. There are many reasons for all this, so I don’t want to sound like I’m pointing any fingers, just stating frequent observations. Given your aversion to mesh, you could even be a candidate for all absorbable material along with the adjunct of Botulinum Toxin A in the oblique muscles to allow healing before the can pull the repair apart.
In any case, you have found an excellent resource Dr. Towfigh has created, and I commend you for taking an active part in your health care. Again, don’t worry – you will be OK. Feel free to call 978 632-0123 for a formal appointment if you would like. I’m in Gardner, MA