Does size of hernia (IH) matter?

[DrBrown]

Dear Pinto.
Even large hernias can be fixed with a pure tissue repair. For the large hernias it is especially important to get the patient in good shape prior to surgery.
Get the BMI down to normal. Stop smoking. No Constipation. No difficulty with urination. Good nutrition.
Regards.
Bill Brown MD

[pinto]

Dr. Brown,

You are great to us in your sharing about Dog’s case and so on. So I hate to ask you to indulge me, but could you tell me what is a large hernia unable for tissue repair? Would the gap be, say, 4 inches or more? (Again thank you for your exceptional kindness by your commentary about Dog’s case.)

[DrBrown]

Dear Pinto.
Unless the hernia becomes huge, a pure tissue repair will be possible.
Wait to have your operation until you are more symptomatic and timing is good for you and work.
Regards.
Bill Brown MD

[pinto]

Dr. Brown,
Thank you for your kind answer. Two doctors told me I am not in immediate danger but urged me to do the operation. I feel in a bind because realistically I cannot get an operation yet. I need to sort a lot things out. However, I am concerned that in time, the IH gap is likely to get larger and so, harder to fix. That seems especially for tissue repair. Thus my question, what range of size is most amenable for repair (or watchful waiting).

[DrBrown]

Dear Pinto.
I would let symptoms be your guide.
If you are not having any trouble, then wait.
Also consider money. If you have met your deductible for the year then you might save money by having it fixed now instead of later.
Regards.
Bill Brown MD

[pinto]

Doctor, you confused me with someone else, but thank you for the reply.
I really though would like anyone to reply to my original question:
Is there a range of size that allows for “watchful waiting”?

[DrBrown]

Dear Pinto.
I do not know the cost of Ovitex. But if they spent a $2m on the robot and they think the mesh is to expensive it must cost a lot.
You have to have general Anesthesia for the Robot. An open repair can be done with sedation.
Your external oblique is probably fine for a Desarda.
I would still advise a non mesh repair.
Regards.
Bill Brown MD

[Good intentions]

“da Vinci” or robotic surgery just offers more potential to get the very fine details right. There is really nothing that special about it otherwise. A good surgeon with steady hands can probably do just as well as a surgeon using a robotic method, for a typical hernia repair. I would not read anything special in to robotic methods for placing mesh. Mesh placement is a fast way to cover a lot of area, without having to deal to much with the fine details of a typical suture-based repair. Mesh placement is probably the crudest way to repair a hernia. Placing a large patch over a relatively small defect.

Ovitex is a new material, introduced to market in 2016. They are using results generated in 2016 to “sell” the product, based on a 3 – 18 month follow-up exam, see the link and click through to “Experience in Inguinal Hernia Repair”. They used the Lichtenstein repair method, an open surgery, focused only on the inguinal canal. I may be wrong, but using da Vinci for a Lichtenstein repair would be unusual.

http://www.telabio.com/ovitex.html

The surgeon for the paper that they are using to sell the product is a consultant for TelaBio.

Overall, you’re asking about a new and unproven, no long-term results, product to be placed via a new robotic technique. You would be an experiment. If you are healthy, except for the hernia, find a surgeon with a long-term track record for repairing hernias. Don’t be a lab animal. Ovitex is a choice for difficult situations but has no data supporting its use for a normal hernia repair, if long-term success is the goal.

” [h=2]Conflict of interest statement[/h]
Consultant for TelaBio.
”

[MinnBobber]

quote DrBrown:

Dear Pinto.
…..
I would advise a non mesh repair.
Regards.
Bill Brown Md

what do you think of hybrid mesh patches, like Ovitex Reinforced Bio Scaffold (RBS)? It is 95% resorbable.
On the surface, it seems like it might be the best of both worlds—-laproscopic small incisions and only leaves the
mesh framework behind. I believe it can also be done with daVinci.

I was looking at Descarda non-mesh but didn’t like that it depends on a strong external oblique aponeurosis
to serve as a patch to cover floor. What condition is my 69 year old EOA likely to be in? What happens if you’re
in surgery and EOA is not in good shape?

Do you know how much Ovitex patch costs? My local daVinci hospital uses traditional mesh, sewn in place.
They said Ovitex was too expensive. How expensive is it??

Do you perform Desarda or Shouldice or Bassini? By hand or daVinci?
There are so many variables???
Thanks for your help

[Good intentions]

quote pinto:

While I sort out how to ultimately get repaired, I am concerned how to live with it. It seems I must do trial-an-error about my living activities, etc. I have been out hip hop dancing a few times and do fitness training with no apparent damage but unsure about practicing golf swings. I don’t even think about playing basketball. Yet fearful to stoop picking things up from the floor. I fear making my situation worse while I eventually make repair plans.

Hello pinto. I was advised by a good friend, who is a surgeon and had his own hernia repaired, that I could continue my sports activities while I waited to have surgery. But I am pretty sure that my rigorous activities made it larger. It went from a small distinct bump to a long bulge. I don’t know if it was more material pushed through a small hole or if the defect itself got larger. So I think that your concerns about activity are valid. It’s a matter of degree. If you weren’t very active in general then a moment of strenuous activity caused the hernia, that would be different than if the hernia occurred during your normal activities, I think.

If you are considering a non-mesh repair I think that it is more effective to repair a small defect than a large one. Mesh is used to cover large areas, but even then the surgeons might change to a different mesh or cover more area if they are concerned about the size. From what I’ve read on the internet.

I’m not sure that you can do “trial and error” with a hernia and your activities. Each tear or increase in hernia size is permanent and there is no warning that it is about to happen. Just like the initial rupture.

Good luck. Be careful.

[DrBrown]

Dear Pinto.
If fear about the hernia means that you can not play the sports that you enjoy, then I would advise you to have the hernia repaired.
Regards.
Bill Brown MD

[pinto]

Dr. Brown, thank you. Would “small” be 1cm≤ in size and would larger the size, the more likely to become symptomatic? While I sort out how to ultimately get repaired, I am concerned how to live with it. It seems I must do trial-an-error about my living activities, etc. I have been out hip hop dancing a few times and do fitness training with no apparent damage but unsure about practicing golf swings. I don’t even think about playing basketball. Yet fearful to stoop picking things up from the floor. I fear making my situation worse while I eventually make repair plans.

[DrBrown]

Dear Pinto.
With a small opening in the abdominal wall, intestines are more likely to become incarcerated, but the risk is small.
Also with a small opening there tends to be more pain when the intestines pop out.
With a larger opening, the intestines will pop out more often, but there tends to be less pain.
Unless you travel to countries where medical care is poor, I would advise you to have the hernia repaired when you start to have symptoms.
You can help by getting your weight down if you are overweight, and to stop smoking if you smoke.
I would advise a non mesh repair.
Regards.
Bill Brown Md

[WasInTN]

Just wanted to let you know some details. IH is not a tumor that grows. In fact IH grows through your pelvic floor hole. IOW, your own intestine or other parts of body that were nicely resting above the pelvic floor are dropping out because of the hole. The hole does grow or may even puncture and cause other problems. the weakness may just expand like a balloon and may not cause any hole.

Does getting heavy matter? Does having large body matter? Depends on many things. If you are like Shaq at 7′ then you can be 230 lb and not considered heavy but if you are 5’6″ and 150 lb you can be heavy.

So what size is bad for surgeon to consider it to be a danger? There is not just one factor.

All said and done, my PCP told me that I had this IH and should be careful not to lift heavy etc in 2005. I, wanted to behave like a smarta$$ and ignored him and had a bulge by 2013 which had to be corrected via surgery. In a way I did wait – whether it was watchful or not. If you have no pains, nothing to worry, follow what your PCP says or better yet see a good surgeon. Do not go to a guy who has a hammer in hand looking for nails to drive. He will just say yes.

Does this answer?