Bilateral hernia – repair only the side that is painful?

[drtowfigh]

As far as we know, fixing one side does not adversely affect the progression of a hernia on the other side.

[Brady]

I mean the risk in general or making one side worse if you only fix the other?

[Brady]

Is bilateral repair any different without mesh?

[drtowfigh]

The discussion of repairing an asymptomatic hernia on the other side of a symptomatic inguinal hernia at the time of laparoscopic hernia repair is an individual discussion you should have with the surgeon. There is no single perfect for everyone.

[alliej]

I hope the dr’s on here can chime in too…This is a good question.

[Good intentions]

quote Brady:

So it sounds like they sometimes do it for precaution since they’re already doing a surgery, but is it necessary or does it increase risk for the other side? Sounds like it’s open for opinion?

I should add that “already doing a surgery” is a term used for laparoscopic hernia repair. Once they have the abdominal cavity opened up.

An open repair would involve two separate procedures, one for each side, maintaining the undamaged tissue in between the two groins.

Another example of how laparoscopy is indirectly contributing to the mesh problem. It’s just so easy to keep going and add more mesh.

[Good intentions]

Hello Brady. I think that you’ll find a wide range of opinions, many contradictory, sometimes from the same person. Not too long ago “watchful waiting” was recommended for small hernias. Surgery itself was considered to add risk so it was better for the patient to wait and see if it got worse.

Now, today, you’ll find many surgeons who will place mesh on asymptomatic hernias. That can only be found during surgery. No pain, no bump, no external sign that a hernia exists. Many will routinely cover as much abdominal area as they can, if they find just a small sign of a defect. It’s just the reality of today’s “standard of care”.

I can say, from experience, that the precautionary approach sounds like a good idea, before surgery. Because the surgeons that suggest it, indirectly, make it sound so easy. “We’ll take a look and if we see anything we’ll “fix” it.” But if the mesh causes a reaction then all of that area that was not a problem before, becomes a big problem.

So that’s your decision – trading one risk for another. Trading one fairly well understood small risk, the chance that the painless small hernia will get larger, for one poorly understood and substantially damaging risk, that you’ll have a mesh reaction.

Try to find a doctor that can defend their method with actual long-term follow-up results, by survey or direct contact with former patients. Somebody that knows how many of their patients have had problems, and why they had problems. If they say “I haven’t heard anything” that just means they don’t know, not that their method is good. There is nothing stopping any individual surgeon from staying in touch with their patients.

Good luck. Be careful.

[Brady]

So it sounds like they sometimes do it for precaution since they’re already doing a surgery, but is it necessary or does it increase risk for the other side? Sounds like it’s open for opinion?

[Good intentions]

It seems that inflammation weakens surrounding tissue. So, somewhat ironically, the use of mesh would most likely increase the probability of another hernia in surrounding tissue, just by the mechanism of its function. Induced inflammation. I’m not sure that anybody can argue against that. Inflammation weakens tissue, weak tissue is prone to herniation.

If you get a TEP implantation of mesh, the dissection process exposes both sides. That’s why they say that they can “take a look” for another hernia. When I consulted with my surgeon about my obvious right side direct hernia he asked probing questions about any sensations on the left side. I said that I felt an occasional twinge. So after surgery, I ended up with full coverage mesh, bilateral, about as much mesh as a patient could receive. He was evasive on what he actually found on the left side, a lipoma maybe.

Learn about the various “states” of the “art”. Many surgeons will implant as much mesh as they can. There is usually no consideration of how the patient’s physiology will respond to the mesh material.

Kent Kercher used to have a video on the Ethicon site where he recommended placing mesh even for asymptomatic hernias. Meaning that there are no symptoms, no pain, no bulges. But it looks like they have removed the video. Dr. Kercher is a paid consultant for Ethicon.

The videos are at the bottom. Just click through as a professional.

https://jnjinstitute.com/online-profed-resources/resources/hernia/inguinal