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Surgery VS Watchful Waiting
Tilbis,
Thanks for the very thoughtful and researched post. I will try to do my best to answer some of your questions and I think once we all weight in you should have a nice overall sense of a small consensus.
1. Pre-Op = Post-Op: I don’s know that there is scientific evidence one way or the other. I think that sometimes its because the original pain was from other sources and I think sometimes that the pain is caused by the patients anatomy/neurogenic in nature and not necessarily the hernia regardless of size.2. Intermittent is typical – Many folks say the pressure and pain gets worse with standing for long hours. Over the say the muscles get tired and become weaker so its a combination of the hernia pushing out and the overall increased stretch of the abdominal wall secondary to fatigue from standing long periods in an already weak tissue.
3. Yes and no on the small hernias – Very small less than 1.5cm or so are extremely rare to have bowel incarceration and strangulation. ” Small hernia’s in the 2-6cm range do demonstrate an increased risk of incarceration and strangulation. Large and very large hernias rarely incarcerate and strangulate in my experience.
4. Yes the hernia can become less painful over time but the pressure is likely to remain the same or get worse.
5. Nerve blocks – Yes and No – Short term they are great but it is a lot of work to get them setup and also a lot of work to maintain the injections every couple of days for long periods of time.
6. Its hard to answer the question with such a broad range of possibilities ( true inguinal hernia or incision hernia from c-Section, etc?) I will say that I do not treat my female patients any different than men and watchful waiting does not have any different effects on women as on men. I believe subjects in that study were indeed men.
Hope that helps a little bit and hope to be of service in the future. Dr. Szotek