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First Inguinal Hernia! Requesting thoughts from the experienced
I’ve been blessed with my first hernia! It is a bilateral inguinal. Not sure if a direct or indirect but appears to be an indirect.
I’m a male age 43 with low bodyfat and in very good shape, very active and enjoy working out 6 days a week. The left side hernia is very small and stays out most always. The right side is approximately 75% the size of a ping pong ball. Right side is very soft and goes in and out very easily. I experience no discomfort from the left side. I experience 15% pain which is all in the right testical…ferls like a throbbing. The right side comes out very easily with standing up to walk or immediately after meal. When it is out my right testical comes up about 1 inch. When I inhale and exhale the right side will inflate and deflate along with my right testical.
After reading the war stories associated with mesh im convinced a pure tissue repair is best, likely the shouldice. So a few questions to help me figure out how to proceed:
1. I’m considering watchful waiting but I’m not used to seeing my testical move when breathing like this. I’m worried waiting can cause damage to the right testical. I’m also worried waiting can give this time to get larger which prevents me the ability to have the shouldice even done. But with covid I’m scared to go to the doctor for a physical exam, diagnostic tests ( which I’m not sure which ones are best to determine if these are direct or indirect) and the fact I have no good quality hernia Doctors close by me in west virginia. General thoughts, advice?
2. Is there a master list on the forum that has all updated surgeons who perform the shouldice repair in the USA? Would love going to the shouldice hospital but being they don’t take my insurance, united healthcare, is a pass. I know of dr Sbayi in new york but he seems too confident telling me he has performed 1000+ shouldice repairs and has a 0% reccurances and 0% complications. I’ve read good things of dr. Brown, towfigh, Grischam, and peterson. I know some of these surgeons do the repairs well but not a high volume of the shouldice specifically. Not to mention most surgeons have not been running full steam ahead with covid.
3. Say the hernias are indirect, I believe I’m good to go with the shouldice. But confused if they are direct I’ve read mesh is best for direct bilaterals. Reading also contradicts this saying direct bilaterals are fine with the shouldice if a first time repair. Thoughts?
General thoughts, remarks are very great appreciated! I’m close to early retirement and now spend every waking moment reading in this or holding my abdomen so it don’t get worse. Not sure which is worse, not doing my biking and workouts in fear or having this done and having complications or a recuurrance.
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7 Replies
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Great questions.
First, watchful waiting has no effect on the health of the testicle. In super giant hernias down to the knees or below (yes, it can happen!), which we almost never see in the first world, we consider orchiectomy (removal of the testicles) as part of the hernia repair, because those are quite complex. Short of that, the testicle health has no correlation with an inguinal hernia.
In finding surgeons, or type of surgery, Search this site for “Shouldice” and some names will pop up. As for recurrence rates and complications, there is no technique that offers 0% recurrence and 0% complications.
As we have said in other posts, pick a surgeon you trust and who can provide you with a variety of options so that you can learn which options suit your needs most. The Shouldice repair is a great repair. It may or may not be the best repair for you. In general, tissue repairs are not as good for direct hernias. Everything is a balance of risks and benefits and what is important to you.
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Mark,
I’m in the same boat as you are. Want to have surgery with Dr. Brown but being on East coast and having to fly right now is not ideal. Also have to convince a friend or family member also to take that risk is even more difficult. May have to wait until things get back to normal and just hope her is doesn’t get worse. -
I couldn’t agree more with going in the tailored approach direction…but real world it is not too feasible because there are so few choices. I think dr brown I a great option which I’m exploring but facing a hurtle of being on the east coast. And I don’t know if any other surgeons who offer a tailored approach in the USA.
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Dear Mark.
There are many types of tissue repairs. The Shouldice is an excellent operation I would advise you not to lock yourself into one choice.
Review.
https://www.sportshernia.com/no-mesh-hernia-repair/repair/
Regards.
Bill Brown MD -
Thank you for this insightful reply!you bring a good question to why I’m going after the shouldice. I guess I have my blinders on a bit because I know that is the statistically most successful pure tissue repair. Too many choices becomes paralyzing..and finding a great surgeon who “does it all” with a taylored approach seems to be good and bad. Good they can taylor it to me. Bad that they may not do a specific repairs frequently enough to yield the best results.
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I am no expert or doctor so take it for what it is ie my personal opinion:
1) watchful waiting is an option, certainly to buy time before you can see a doctor (or to avoid mesh, this would be my case btw)
2) an expert might be able to correctly say if it is a direct or indirect by e.g. using ultrasound, but it is not 100% precise (same goes with the size I think)
3) a tailored approach means you will get the surgery that is best for you, which might mean Shouldice or another procedure: any reason why you absolutely want Shouldice? if I could do it, I would go for the tailored approachHow badly is your life style affected? leaving aside the danger of incarceration that ALL surgery sites/surgeons mention in bold as a reason to get surgery as soon as possible (apparently the chance of this is pretty low), I am not sure how founded it is that the hernia gets bigger quickly and this will mean you cannot get a tissue only repair (somewhere in this forum Dr. Kang mentioned that a tissue only repair in his opinion is almost always possible, barring some cases with other morbidities): I may be wrong on the tissue only repair being almost always possible, which I would like to hear some opinions from other more knowledgable members…
As for the testicle being affected/compromised I cannot say: I would have thought that so long as the blood supply to the testicle is not compromised there is no damage…
My 2 cents
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Dr towfigh – thank you for the response…I can now breathe and be more patient getting the surgery having less sense of urgency knowing my testicle isn’t is danger. Panic started when I thought the blood flow was being cut off when I saw it moving when breathing…but priceless response thank you!
Alexander – were in the same boat…I agree tend to lean to wait for covid to subside before going out west for the dr brown repair. I’m also facing having my urinary retention bph issues resolved before the hernia repair as if the hernia wasn’t enough!
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