Hernia – Surgery or No?

[pinto]

If I take my car in for an oil change but end up getting an unapproved engine overall, I would have solid grounds for compensation. Isn’t your situation like that? “I didn’t have a hernia at any point I had some overuse tearing in my groin as a professional dancer – and the one big surgery I got bilaterally was through … ‘sports hernia repair’.” Before surgery did you agree to or request a sports hernia repair–a bilateral one to boot?

[pinto]

@peterc, it’s been devastating for you, just devastating. You didn’t have a hernia but ended up getting a bilateral IH operation? Do I have that right? I’m really sorry for you. How mobile can you be? I’m unclear how you got where you are. Has an attorney helped to sort things out? Was your identity mistaken in the hospital? We hear sometimes of hospital mix ups behind wrongful operations. How is it that you got an operation completely unexpected, if you don’t me asking.

[PeterC]

Not sure where her hernia is situated but I will say this – if she doesn’t have pain – don’t rush into surgery. These surgeons keep telling people that ”it cannot heal” and ”itll only get worse” to get you into surgery. Suddenly those people who only went preventively to get ahead of it like their surgeons suggested are stuck with severe dysfunction and/or pain.

I know of 2 people who had an actual hernia and they don’t anymore and they didn’t have surgery. Its not bulging anymore and they can’t feel it anymore.

Every surgeon I’ve talked to so far in my journey has lied to me and downplayed the effects of their procedures which were always worse than my initial reason to consult them to make a buck. I promise you its a better life to watch it and hold off vs. doing it because the doctor is underselling the severity of some of those operations and then ending up with chronic pain or muscular dysfunction.

Good luck with everything.

• This reply was modified 4 years ago by  PeterC.

[cm-rom]

I would recommend mesh based repair if she is symptomatic or if the hernia is growing in size..

Hernia is growing in size: is it the sack or the defect? Or both?
Presuming it is omentum that’s adherent to the sack (MRI), not fully incarcerated, can someone expect to reach an equilibrium of sack’s volume at one point? How would someone weight the risk of omentum gangrene/ischemia or even possible bowel/mesentery absorption into the hernial sack, in such cases where defect is ~ 1.5 inches? What is the trigger to crossover from watchful waiting before it is too late? Is there a golden ratio between sack volume/sack neck implied?

Thank you!

[Good intentions]

An excerpt from the article, at the end.

As to which approach and materials are best, again, there is no consensus. “When we look at all the ventral hernia repairs in contaminated fields—randomized to suture, synthetic and biologic—we find little difference,” Dr. Moran-Atkin said.

There tend to be fewer surgical site infections associated with suture repairs, and recurrence and reoperation are seen less frequently in patients who receive synthetic mesh, but no approach appears to be statistically significant to another. “Really, just do whatever you can to get it closed.”

[Good intentions]

Here is an interesting article indirectly related to incisional hernias.

You can register for the site pretty easily to view the full article. It’s worth doing.

https://www.generalsurgerynews.com/In-the-News/Article/05-19/Hernia-Repair-in-the-Obese-Patient-Little-Consensus-Among-Surgeons/54956

[Good intentions]

Here is a previous discussion about all of the variation in materials and method. Who can say which combination is best? Nobody tracks results and most patients only know that they got “mesh”. Most of the new devices are attempts to increase market share of this multi-billion dollar industry.

https://www.herniatalk.com/8126-types-of-mesh-now-being-used

[Good intentions]

quote drtowfigh:

Let’s not conflate chronic pain after inguinal hernia repair with that of incisional abdominal hernia repair. Two different animals with two different outcomes.

Remember that not all mesh are the same. There is a wide variety of mesh options and surgical techniques, each with their own risk for recurrence and pain.

If inflammation is the cause of the chronic pain/discomfort then location should not matter. It’s localized to the mesh placement itself. Transvaginal mesh and hernia repair mesh have similar problems.

And, as I’m sure you’ve seen and possibly discussed with colleagues, many hernia repair “specialists” just use whatever mesh their purchasing department provides. They consider all “mesh” to be essentially the same. Or they choose their device based on their relationship with the sales rep from the device makers.

(Click “cancel” inthe print window and the article will show) https://www.generalsurgerynews.com/Article/PrintArticle?articleID=34826

So there is the heart of the problem for any new hernia patients. Who really knows what they’re doing and what the potential problems are, and has the patients’ best interests at heart? Everybody needs to be very careful, the opinions about best practice are widely varied, there are many ways to go wrong, and the oversight of the industry is very poor. If you make the wrong choice, fixing that mistake might be impossible. “Get the mesh” is a terrible way to approach the problem.

[drtowfigh]

Hernia is not uncommon after emergency surgery and after colorectal surgery. The repair is mesh based and tissue based repairs are more likely to cause pain and disability, because of tightness and tearing that may occur after the repair.

Let’s not conflate chronic pain after inguinal hernia repair with that of incisional abdominal hernia repair. Two different animals with two different outcomes.

I would recommend mesh based repair if she is symptomatic or if the hernia is growing in size.

Remember that not all mesh are the same. There is a wide variety of mesh options and surgical techniques, each with their own risk for recurrence and pain.

A hernia specialist can help walk your mother through her options and with realistic outcomes.

[Good intentions]

My view is that every effort should be made to avoid mesh. Mesh products should be the last resort, due to the high probability of chronic pain.

I’m not a surgeon so don’t know the numbers on incisional hernia repair hernia recurrence if a suture repair is used. They are probably out there somewhere though.

[localCivilian]

[USER=”2029″]Good intentions[/USER] As far as incisional hernias, is there really another option than mesh though? I rarely hear or read of incisional hernia repaired by sutures. Most incisional hernias are of decent to great size (unless a trocar site hernia) and I assume they grow rapidly. I can only imagine how fast a recurrence would happen if done only by sutures, especially with a good amount of risk factors (smokers, obese, etc…)

[Good intentions]

It is still amazing how many doctors and surgeons just don’t seem to be aware of the potential problems of mesh implantation, and the very high odds that a patient will have problems. 1 of 6 seems to be the number of patients that will develop chronic pain or discomfort.

Read through the Topics on the site and you’ll find much about the dangers of mesh implantation. Find a hernia expert, not a general surgeon who does mesh implantation. It might take some looking because many of the surgeons who implant mesh feel like they are well-trained in a mesh implantation method, but are not really experts in hernia repair.

Unfortunately, in today’s environment, you can’t just trust the title of “surgeon” or doctor. You have to dig deeper. Your mother’s greatest risk is getting a bad mesh implantation and developing chronic pain or discomfort, it’s not the risk of recurrence.

[PeterC]

@pinto I didn’t have a hernia at any point I had some overuse tearing in my groin as a professional dancer – and the one big surgery I got bilaterally was through Dr. Brown and his ”sports hernia repair”. The reason I’m so messed up is because he does his own made-up procedure which is a mix of shouldice & desarda (so a mix of 2 hernia procedures even though I had no hernia at any point just some tearing in the groin muscles) where he cuts into too much healthy tissues to patch you up like a pair of jeans and you simply can’t do that to tissues. He breaks the structural integrity of the muscles and causes permanent weakness by doing so. The worst part is he misdiagnosed me & I have athletic pubalgia (over-use tearing at the pubic bone attachment) so I still have most of the pain & symptoms I had before his procedure but I have SEVERE weaknesses across my body. My left side had a 1 inch external oblique tear which is supposed to be a simple repair where you sow the tear in the external oblique to help it heal (since it has poor blood flow) – a classic overuse injury. I woke up to a full shouldice/desarda repair, 3 new attachments into my inguinal ligament, cut out flaps of my external oblique etc.

I’ve had a 6 pack my whole life & very healthy core tissues/activation and I haven’t been able to flex my core properly since his procedure 16 months ago. I knew something was very wrong when I realized that my entire core/abs had completely released (went completely loose) after the surgery. They’re not supposed to do that. When you get any abdominal surgery, the rest of the core will actually tighten up around the scar to stabilize/compensate for the weakness around the wound. But after his procedure my entire core from pubic bone to ribs were released & the strength was entirely gone across the whole thing and my lats were completely released as well (they stem from teh external oblique tissues) and haven’t worked since.

I think the saddest part is I had asked about all this before agreeing to the surgery. I asked is your procedure going to affect the rest of my core by being too invasive/will it impair the rest of my core/will it affect it and he said no. Sure enough it did. Additionally I’ve developped knee problems & hip problems since because all the strength/natural tension that normally help someone walk & hold the hips aligned is gone. The right side of my rectus abdominis completely collapsed too you can tell its completely loose.

I think what hurts me the most & is messing me up psychologically the most is – it took me 2 years to get the courage to trust a surgeon again when I went to him. And while I had chronic pain in my groin, I was still able to dance professionally, I went on daily walks in the park, etc. I only decided on surgery because I realized it wasnt healing and I thought I need to get it repaired I cant just push through pain for the rest of my life. Hell – even if he didnt completely fix all the issues I wouldve been okay knowing that there’s still hope. But he made me so much worse. he created so many problems. so many issues – there was such a disregard for my tissue health that I’m realizing that I have no hopes of ever recovering back to 100% – something I had before he operated on me. I don’t even think I can withstand another surgery. That’s whats been messing me up psychologically. I’m not interested in suing, or anything similar. What good is it going to bring me? I just wish these doctors would stop a second a realize that we’re real people they’re messing up. And I’m not alone – someone in my city who isn’t a professional athlete had the same sports hernia ”repair” with Dr Brown and hes on his 5th revision surgery from that surgery. There’s something extremely wrong here.

The goal should be to do the least amount of collateral damage as possible, but in his case he does the absolute most amount of damage possible or rather theres a complete disregard for tissue health. Since having his procedure I’ve been on exactly 8 walks (in 16 months) and every single time I came home from one I’ve thought about ending my life because I cannot accept how messed up I am and how uncomfortable and weak it feels. I can’t lay on my back because I’m uncomfortable breathing – his procedure affected my diaphragm and my breathing as well.

Anyways I could go on and on but you get the point. I have a doctor who says he can put the muscles back to where they are supposed to be/re-attach the things Dr Brown detached but they will stay dysfunctional because the damage has been done to them already. So yeah I don’t know. I haven’t had the courage to end it. I’m terrorized of doctors and I haven’t had the courage to continue seeking help. Most people can’t believe what they’re reading when theyre reading Dr. Brown’s operative report & physios cant help me because you cant rehab muscles that are mangled & attached in unnatural configurations. I went completely silent and stopped talking to all my friends/colleagues because I don’t know how to cope & don’t know how I can be around anyone like this. The few people I’ve talked to about it cannot believe how healthy of a human being I was and how miserable I look now & they just have pity in their eyes for me.