HerniaTalk **LIVE** Q&A: Watchful Waiting for Hernias 05/10/2022

[David]

I tried to edit a few phrases and the edit didn’t take. Was this due to timing?

[David]

Thanks Good Intentions for your good comments.

I finally was able to watch the rest of the interview. Here are a few things learned.

Recurrent hernias are more commonly symptomatic than original.

They talk about which hernias are generally ok for watchful waiting. The doctor makes a strong point that femoral hernias in females should not be watched, that 40% of these will end up in the ER or with strangulation.

In general, a primary abdominal wall hernia that is not symptomatic can be watched.

In answer to the question of whether watchful waiting makes a repair more difficult as it grows bigger, whether it can cause it to form adhesions, or make it only treatable by mesh…..

He says this is true if it gets to be a large size. 5% of patients want tissue repair from him, though population studies show a 15% failure rate of tissue repair over time, compared to 1% by mesh. That tissue wears out like the tires on a car.

(I was hoping they would talk about at what point the size starts making a difference.)

He seemed happy to do a tissue repair if a patient asks, though. he does the three layer Bassini as was originally described by Bassini and not the modified Bassini that was imported to the U.S. and that was not nearly as effective.

The Bassini uses interrupted sutures and the layers are sutured to the inguinal ligament. It was a quick description that I may be incorrectly stating. He uses a Bassini because it’s a good repair, and he doesn’t feel as comfortable doing the Shouldice.

Dr Towfigh says that the use of stainless steel sutures in the Shouldice is a financial decision. (Apparently not functionally that necessary, I guess. Interesting)

There have been three trials on watchful waiting. Both doctors disagreed with the conclusion in the UK trial that watchful waiting should not be done due to the possibility of a heart attack or other problem that would interfere with surgery when later needed. Their conclusion was that data from that trial, too, suggested that watchful waiting was mostly safe.

They made comments on surgery being physically taxing. (this might have been primarily with regard to open surgeries.) Dr Towfigh once had a surgery last 12 hours!

Last few minutes were spent on thoughts about nerve problems and how to deal with them.

[Good intentions]

It is interesting how the surgeons seem to view their bodies differently than their patients’ bodies.

Here is an old tweet on the watchful waiting topic. Even though they could die or end up in the emergency room from an incarcerated hernia they choose to wait. Very strange.

The choice of surgery method is not the same as what you saw though.

https://twitter.com/Herniadoc/status/1114246402950012930

Fascinating audience polling by @DrMicki of laparoscopic general / hernia surgeons. Here are 3 questions:

Q1: how many of you would have your minimally symptomatic inguinal hernia repaired?
A: 56% choose watchful waiting. pic.twitter.com/oZ0RCpcknH

— Dr. Shirin Towfigh (@Herniadoc) April 5, 2019

[David]

I’m about halfway through watching this interview on watchful waiting and the guest doctor just made the comment that he does a lot of surgeries on other doctors, and they, more often than not, choose to have it done open. This seems to have something to do with their wish to avoid general anesthesia.

[drtowfigh]

The king of watchful waiting answered all our burning questions. If you missed it, you can watch it here:

https://youtu.be/RpulDqYVy5A