Advice on the least painful hernia repair?

[JHawley]

Diagnosed with a hernia on my left side. I see there are a number of ways to fix it. My doc says Laproscopic surgery is the least painful surgical option. Is there any surgical fix that has a track record of causing less pain than another? A friend of mine had an open mesh repair and he said it hurt for about two weeks. Any advice appreciated.

[Good intentions]

Take some time, a lot of time, and read as many posts on the forum as you can. Think about what you’ve read, then read some more.

Your question is way too simple. There is the pain of the surgery and the potential pain after the surgery. Worry about the long-term, not the short-term. Two weeks is nothing compared to the 40 – 60 years you probably have ahead of you. How is your friend doing today?

[David M]

Lap does seem to come out on most studies as the least with pain, but I’m not sure about how superior it actually is.

Plus, this forum has had a surprising percentage of people who have felt significant discomfort due to lap mesh.

• This reply was modified 3 weeks, 1 day ago by David M.

[David M]

I made a link to gather several links from pain studies together, but the forum is broken to a degree and mistakenly links incorrectly to a different link.

[JHawley]

Thank you. Do any of you have any recommendations. I have been reading posts here but there is a lot of inconsistency. Lots of people who did no mesh repairs seem to have pain too. My friend said his open mesh surgery was a breeze but I guess it could go bad in the future? It seems like every study online shows laproscopic with a lower risk of pain. Any advice appreciated.

[Good intentions]

” Lots of people who did no mesh repairs seem to have pain too. My friend said his open mesh surgery was a breeze but I guess it could go bad in the future? ”

You have to be careful as you read and take note of who is writing the posts. A member who recently joined the forum and posts a lot, for example, tends to over-generalize and exaggerate things. Your post above is kind of like that where you say “lots of people”, and “was a breeze”. First you said that he had two weeks of pain, now it was a breeze. You didn’t say how he was doing today. You have to be precise in your thinking. It’s difficult.

There is no simple and clear answer. What type of hernia do you have and how long have you had it? How physically active are you and how and is the hernia now? Does it hurt?

Good luck.

[JHawley]

I dont know the type. I have had it for a few months. It doesnt hurt. I am physically active. It seems there is a risk balancing test. Less short term pain less risk of recurrance with mesh vs. more short term pain more recurrance risk but no mesh risk. I had no idea this was such a thorny issue. My friend said it was nothing just in and out the same day sore for about a week or two then fine. Doesnt know its there. I read a post from a guy who went to shouldice and is still in pain 8 months later here. My doctor is saying they almost always use mesh because its less painful and less chance it will come back. What do you recommend?

[JHawley]

The information on this forum is quite troubling. I thought this was a routine surgery. It doesnt seem as if anyone gets a good result? Just from a logical perspective it would seem that a “tissue” repair would be more likely to cause chronic pain than a laproscopic repair. That is what my doctor is saying and that is what the studies seem to suggest. At least the studies I am finding on the internet. Is there any consensus about an appropriate way to fix this? My hernia appears to be small. My doctor is saying its best to fix when small as its easier to fix. He claims he has not had any issues with long term pain.

[Good intentions]

There are very few things that are certain in the field of hernia repair. Here are a few things though, that are close.

Avoid getting any type of plug repair. That is the only type of repair that the European Hernia Society could agree on to not recommend.

Choose your surgeon based on what they will do if you have problems. One thing that seems endemic in the community of hernia repair surgeons is that most of them will avoid you if you have problems. You don’t want problems and they don’t want to deal with them, but if you do have them you definitely don’t want to spend time starting a brand new search for a hernia problem surgeon. There are two main things to consider – the odds of having problems, and the difficulty of fixing those problems if you have them.

If you have to travel and spend extra money to get to a surgeon that you feel gives you the best odds, do it.
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If you have a small hernia, beware the surgeon that wants to check the other side during a laparoscopic mesh implantation. You will probably end up with mesh on both sides. Also, if you have a small painless hernia, there is no valid reason for a neurectomy. Neurectomies cause numbness. Neurectomies had in the recent past been only advised for pain relief after pain occurred. But many surgeons do prophylactic (preventive) neurectomies. It is unethical but it’s what they do.

If you’re having a hard time believing that the decision can be this difficult look at how many different types of hernia repair materials there are, and how many different methods of repair. Why so many, and so many combinations of mesh and method? Why is mesh removal becoming so prevalent and advertised? Why are there so many mesh lawsuits?

Finally, remember that no matter how well-meaning your surgeon was when they started the path to becoming a surgeon, at the end of each day they have to “make the sale”. Surgeons get paid to perform procedures, not for making the best decision for their patient. It’s just a reality of medicine as a business. Hernia repair is “bread and butter” business for any surgical practice.

Sorry. Spend some time and try to absorb your new reality. Find a doctor and/or surgeon that you can trust. Ask the surgeon what they would do if they had a hernia, and watch their response carefully. If you want to talk to real people with real hernia repairs, find many, not one or two people from the gym or wherever.

[JHawley]

That is good information thank you. Is there a type of repair you beleive to be the best option? And a surgeon you recommend?

[David M]

JHawley,

You’ve been here before?

[Watchful]

Chuck is having fun again 😉

[David M]

Are we up to ten yet?

[Watchful]

Possibly. My favorite was the original Chuck, and the most surprising was when he appeared as a skinny girl with a hernia, although that character wasn’t nearly as well developed as some, like Dconfused77.

Now he’s a senator, so I’m eagerly looking forward to how this character is developed.

[JHawley]

David M I found this board when listening to a you tube video with Dr. towfigh. I was diagnosed recently. Watched some you tube videos on mesh danger.

[Good intentions]

Josh Hawley’s colleague Rand Paul went to Canada to get a Shouldice repair. That fact might have some value.

[Watchful]

The Chuckster has a penchant for riddles in addition to his sense of humor.

[William Bryant]

The problem with this surgery, as you’ve discovered, is one person will get a brilliant, trouble free result with surgery technique A, and another person a terrible one. The same is true for all types of hernia repair.

What makes it worse is there seems to be little effort from surgeons, health services, profession bodies etc to follow up and find the most effect, least problematic hernia surgery of all – which I’d have thought would be in everyone’s interest.

Open with mesh seems to me the best of the mesh types.

Tissue repair is not so obvious to me. Desarda/Kang less invasive. Yet Shouldice is the only one we know that hernia surgeon’s have chosen to have done to themselves.

As Chuck once said choose … “Then pray”. Or as watchful put it… It’s Russian roulette.

Bizarre that it is thus considering it’s not new surgery and is one of the most performed.

As for size, I can see dealing with a small hernia may make it easier to fix but if asymptomatic it could be trading no issues for years of pain if surgery results in that side effect.

A dilemma indeed with no easy answers.

[Watchful]

This is true in medicine in general. Same treatment or procedure for the same condition, different people, totally different results. This is not unusual. Even with the same person – same surgery for bilateral hernias, possibly different results on the two sides.

If you think this surgery is problematic and with unpredictable results, look at some others like spine surgery.

[William Bryant]

Yes I forgot to put that but then again this is described as routine and a very common surgery not sure the same can be said about spine or brain surgery (thankfully). Also I think more or most people would be aware of the dangers of those but hernia is ‘sold’ as relatively risk free. Or low risk and the common theme amongst mesh injured is they were not told the risks, wish they had been, that was with the old meshes etc etc.

[Watchful]

At least in the US, there isn’t much transparency about the risks and outcomes of other surgeries as well. You’ll get some boilerplate in the notes about risk of infection, etc. but that’s about it. Surgeons are eager to operate even in questionable or unwarranted cases, and patients have a very low bar for agreeing to surgery if some doctor says they need it. I don’t think it’s the same in the UK because of the nature of the healthcare system there (probably too extreme in the other direction).

I’ll give you an example. I have an asymptomatic thyroglossal cyst which was discovered accidentally in imaging. I went to an ENT who recommended surgery because of the risk of cancer or other trouble. These are extremely low risks, and I have most likely co-existed peacefully with this cyst my whole life. Still, I was told I needed surgery. I had another imaging done a couple of years later, and there was no change in the cyst. The ENT still wanted to operate. No discussion of the risks of this neck surgery, or of the risk/benefit tradeoff.

[JHawley]

It seems that there is some inside joke that I am not privy to here. Is Chuck a moderator here? Is he available for advice? Just looking for advice guys. Would most of you suggest a no mesh approach? I don’t even know where to start with that. Is there at least a surgeon that everyone acknowledges is the best? I see DR kang mentioned a lot. And shouldice seems to be the most popular mesh free repair. Has anyone here had a shouldice repair and had no pain at all? My co worker had double open mesh and no problems at all for ten years. Spinoza seems to be doing well. Is it fair to say that open mesh is less invasive than shouldice?

[Good intentions]

There is a person with the screen name of Chuck who got banned from the forum because his posts were disrespectful. After he got banned new members started appearing on the forum that wrote in a way that sounded just like Chuck. Dconfused77 is one of them, and eventually Dconfused77 admitted that he actually was “Chuck”. So if you read old posts from Chuck keep in mind that he and Dconfused77 are the same person. There are others that are almost certainly Chuck but are unconfirmed.

You, JHawley, write like Chuck/Dconfused77. It seems very likely that you are another one of Chuck’s internet personas. If you’re not Chuck, then good luck to you. Each new Chuck persona gives forum members an opportunity to rehash old thoughts and put them out here for discussion. Chuck does not seem to get anything from the discussions though, he keeps coming back with the same questions and comments.

I’m reminded of an old spooky movie from the 70’s – Sybil.

I’d like to see JHawley, Dconfused77, Chuck, Joe, and some of the others all signed in at the same time. That would take some work.

[William Bryant]

Watchful, do you still think delaying surgery is a viable option? I know you used today you’d had 8 us years of relatively normal life but do you still feel waiting is advisable? Do you think you would have got same result with a shouldice if you’d had it sooner? Thanks

[Watchful]

William,

My case wasn’t a good fit for Shouldice for two reasons. A very large defect size, and a “deep anatomy” (my surgeon’s terminology). If I hadn’t waited so long, my defect size would have probably been a bit smaller, but I doubt this would have been enough to make the difference.

I don’t think my mistake was waiting too long. My mistake was going to a surgeon who wouldn’t tailor the repair. I should have gone to Conze or Lorenz. I’m still a big believer in watchful waiting.

[William Bryant]

Thanks Watchful. I’m so unsure of the surgery I’m just hoping I can delay it for a while.

[Author]

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