Hernia surgery if small and painless? During covid?

[drtowfigh]

Great!

[D]

Jumping back in to say I did get the surgery and it went well. No mesh was used, surgeon did a good job. Took a month or so two til it felt healed, had some gnarly swelling and bruising, but that’s par for the course with open surgery, I have heard.

[pinto]

Let me clarify again, please: the “complaint” you refer to by surgeons was not about mesh. My understanding from reading various accounts by patients was that IH size is not irrelevant. Indeed you will find medical researchers using IH size as a variable in the study of treatment efficacy and so on. Further you yourself found one or more surgeons who indeed consider size an important determinant in treatment:

I have seen this myself i.e. … this-time-mesh surgeon saying at the same time that it was too big for a pure tissue repair)

While you support, perhaps unwittingly, my assertion about the importance of IH size, let me be clear that the patient reports were not about treatment per se. Rather some of the patents lamented that they may have waited too long before surgery (given surgeon/doctor reactions). Because IHs cannot/do not heal naturally, a certain percentage of patients ultimately turn to surgery. I suppose mesh methods allow a longer waiting period than pure tissue repair (cf., your own report).

I am still uncertain about early surgery vs watchful waiting, especially when there are no symptoms:

Then you can wait. You have the backing (from my experience) of the UK national health system and scores of medical opinions I have seen about this. My personal view is that we must weigh how much we trust the local emergency hospital room for surgery. It can happen.

My own dentist had to get emergency treatment. He didn’t seem to mind that mesh was used. But in such case even if mesh, you have no choice about the type and the manufacturer of the device (besides the fact your surgeon will likely be inexperienced and training to become a “jack of all trades.”) On the other hand, larger herniae might be less risky than small ones (please confirm with your doctor). Here again IH size is an important factor–risk assessment for strangulated IH. I rest my case. 😀

[Alephy]

I think some surgeons will always “complain” that they had to use mesh because the patient had waited too long and the hernia was too big, it is the usual dismissal for a pure tissue repair (I have seen this myself i.e. a specialist saying my hernia was small, and another this-time-mesh surgeon saying at the same time that it was too big for a pure tissue repair).
I may agree that a bigger hernia may be more problematic to treat surgically (I let the doctors comment on that), but I am still uncertain about early surgery vs watchful waiting, especially when there are no symptoms: the reason behind is that a pure tissue repair is also not risk free (how low must it be for one to decide for the surgery?)

[pinto]

Let me clarify: “need” differs about meaning or context. Reading across the internet various IH accounts, I found a common thread about surgeon comments reported by patients about size, such as the lament that certain patients hadn’t come in sooner or that smaller ones were less complicated than larger ones. So I agree that size doesn’t necessarily mean the need for surgery, however if one wants pure tissue surgery, the smaller the IH, the better based on those patient reports.

If your report accurately reflects Shouldice, it makes sense that they would do so. Watchful waiting, for example, is the preferred approach by the UK national health system, meaning that patients necessarily need not rush into surgery. If an IH is small and not “symptomatic” (not troublesome), one can confidently wait. But again if talking about pure tissue repair, there must be a point when waiting becomes dangerous. Surely a bowling ball sized IH is greatly more concerning than a pea-sized one. All of that, however, is made mute by mesh. But D’s reporting shows preference for pure tissue repair, thus my original post.

[Alephy]

If this were true, I would expect the Shouldice clinic to treat the smaller sized hernias preferably, while it seems as though they opt out when the hernia is smaller than a certain size somehow…..

[pinto]

>Size is not a determinant of need for inguinal hernia surgery.
Isn’t that assuming mesh surgery? But I believe it’s different for pure tissue repair, D’s apparently favored approach.

[drtowfigh]

Size is not a determinant of need for inguinal hernia surgery. If you have symptoms, the benefit to your quality of life favors hernia repair. If you have no symptoms, you can safely watch it with 0.18% per year risk of complication, such as incarceration. So, it’s low. I encourage watchful waiting for most of my patients.

[Wim]

RIsk is small, but there is difference between direct and indirect hernia. Due to COVID all non-urgent surgery is cancelled in Belgium. And we don’t have specialized hospitals like in USA, Canada.

[Ben999]

Adding onto previous responses as a “hernia veteran” I would advise against it, as did my surgeon (Dr.Conze).

I was/am in the same situation with a small hernia on my right side that is slightly symptomatic (only when running/walking long distances). I was about to schedule a surgery but decided against it following Dr. Conze’s advise and I don’t regret it. Since the cancelled surgery, which was 4 months ago, that hernia has bothered me maybe two or three times.

• This reply was modified 3 years, 11 months ago by  Ben999.

[Wim]

How do you define “Asymptomatic hernia”? I have a slightly visible bulge but no pain.

Or means “Asymptomatic” that there is nothing (fat or bowel) going into the inguinal canal?

[DrBrown]

Dear D.
the risk for incarceration is small, so if the hernia is asymptomatic then it certainly does not need to be repaired at this time. If you take 100 patients with an asymptomatic hernia, in 18 months about half of the patients will decide to have the hernia repair because of symptoms.
if you travel to 3rd world countries a lot, that would be a another reason to consider hernia repair at this time.
but watchful waiting is a very good decision.
Regards.
Bill Brown MD

[JamesDoncaster]

Given how serious the risk of chronic pain is from any hernia procedure (either with or without mesh), there’s no way I would opt for surgery unless my hernia was causing me pain or was dangerous.

[Alephy]

You should ask the surgeon and agree in written form on what they can or cannot do….my 2 cents….if necessary take your time and don’t rush for it

[D]

It doesn’t hurt at all. It slips out a couple times a day, but usually reduces after I lie down for a couple minutes, so doesn’t get in my way too much. Mainly just worried that it would get worse, tho various sourc s say it’s pretty safe to wait. The procedure is definitely a modified shouldice, at least in that he doesn’t use the stainless steel sutures. I am a bit concerned he might fall back on mesh if there’s a problem, though. Would a surgeon commit to not using mesh, if they thought it was the only option or necessary? I bet most of them wouldn’t.

[Alephy]

I think doctors (the real ones) tend to say that if the hernia doesn’t bother you and it’s not in the way with the life you want to live, then don’t touch it…so does it bother you or get in the way? There are then those doctors that will tell you that it’s dangerous because it can get strangulated, that it will get bigger and more painful, that it’s better to do it sooner rather than later, that it is easy no recurrence very low chronic pain rate etc etc: stay away from them

[Good intentions]

You’ll find quite a bit out there also, about surgeons who say they do the Shouldice procedure but actually do something different. Different sutures or a “modified” procedure. You might not actually be getting the procedure that gives the excellent results.

And, it’s not uncommon to go under general anesthesia expecting one thing and wake up finding that you got something else. Your surgeon will probably tell you that they will do their Shouldice procedure unless they think that mesh will give a better result.

Finally, your surgeon is probably “gung-ho” because business has dried up and he/she needs to catch up. No patients means no cash flow. Hernia repair is the cash cow of the general surgery practice. High volume and a steady supply of patients.

Be very careful of the things that you would normally be careful of even without the COVID problem. If I wanted Shouldice I’d go to Canada, to the Shouldice hospital.

[D]

I’m in Illinois, we’re doing better than most states but the numbers are slowly rising. I feel like the procedure itself will be pretty safe, but all the additional follow up visits and waiting room time, plus the risk of complications putting me in an urgent care or something, are small but not zero? I’ve also realized from this site some people wait YEARS to fix their hernias, and maybe there’s some logic to that instead of rushing into it…

[Alexander]

That’s a very fair question. What state do you live in? Generally, I would say that you will be safe – the hospitals have very strict protocols in place and if they are still doing elective surgeries then I wouldn’t worry too much about getting covid. Most likely you and every other person having surgery will get tested the day before or the day of surgery and all of the staff surely will be wearing masks.

[Ben999]

Yes, but smaller than that. Did your doctors not say anything about incarceration risk? Did you ask?

[Wim]

But did you have a visible lump? Mine is half of an egg-size. It doesn’t bother me neither, but still i don’t know if it is indirect (with greater risk it will go bad ) or a direct hernia. The 2 docters +1 echograph specialist I consulted didn’t precise this.