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  • Inguinal hernia – pls help with advice

    Posted by norton on December 17, 2016 at 4:26 pm

    Hello. I’m new to the forum and seeking advice. I am impressed (but somewhat overwhelmed) by all the information and knowledge here concerning what to do for an inguinal hernia.

    I am aware that watchful waiting is an option, however I am seriously considering surgery in the next six weeks or so. Currently, pain or discomfort is fairly low level and manageable, but the sensation is fairly constant, and a worry when I exercise or even engage in everyday activity. I know I have a tendency to obsess on something like this, but it is on my mind a lot and limiting what I do. For this reason, I am thinking that I probably will have surgery.

    At this point, I have two questions:

    1. How effective is exercise in terms of stopping the progression of an inguinal hernia? I’ve read about pilates, transverse abdominus strengthening, etc. and their potential. Even if this approach didn’t lead to healing the hernia (I read at least one report of an actual healing through exercise), does anyone have any experience or knowledge about exercise keeping the symptoms in check?

    2. My second question: As I’ve mentioned, I think I will probably end up having surgery in the next six weeks or so. I am just now learning that the majority of surgeons use mesh in their repairs. However I am also hearing that, where there are post-surgical problems, the use of mesh is often felt to be the cause.

    I have found a surgeon who is very experienced with non-mesh repairs, but he’s a short distance away from my home. Nevertheless I’m quite willing to travel, if there are arguments in favor of NOT using mesh.

    I know there will be various views and opinions on mesh and that this is a big topic, but I’m wondering, as a “bottom line”, does the overall evidence point to mesh as being a problem? I know that evidence is never really definitive on something like this, but I’m wondering: Even if it’s not possible to say with certainty, does the evidence, or do people’s experiences at least call into question the use of mesh (in terms of quality of life after surgery)?

    Thanks so much for any thoughts or advice on this! I’m just not sure what to do.


    drtowfigh replied 7 years, 1 month ago 3 Members · 4 Replies
  • 4 Replies
  • Beenthere

    January 9, 2017 at 6:43 pm

    Inguinal hernia – pls help with advice

    Hi Norton,

    I will start out with my standard recommendation and that is to read the book Unaccountable before proceeding, unless it is life threatening.

    My history is long but I asked all of the right questions and got all of the right answers only to find after my surgery that my expert who had done well of 1,000 open surgeries with excellent outcomes had done none in the previous 18 months and the hospital itself had 25 to 30 percent 1 year post surgery pain issue. So be VERY CAREFUL.

    The surgeon and their knowledge and experience are crucial. If the surgeon does open with mesh all of the time like Dr Goodyear that would be the surgery I would go with with Dr Goodyear.

    It is very hard to find a pure tissue surgeon in the US, it seems to require more skill and time to perform.

    The question I ask would I chance a smaller figure for a reoccurrence maybe in my lifetime or a higher chance for a lifetime of pain with mesh? Looking back I would have gone with a pure tissue surgery if I could go to a specialist but my insurance did not allow me to.

  • drtowfigh

    December 17, 2016 at 5:21 pm

    Inguinal hernia – pls help with advice

    Yes. All core strengthening exercises are considered protective of hernias. In some situations, hernia pain resolves with appropriate exercise and strengthening.

    The recurrence rates vary from surgeon and based on patient factors.

    Most reported recurrences for mesh repair range from 0.5% to 5%. Usually 1%.

    For nonmesh the reported recurrences range from 1% to 17%. Usually just under 10%.

  • norton

    December 17, 2016 at 4:59 pm

    Inguinal hernia – pls help with advice

    Dr. Towfigh
    Thank you so much for your reply. Much appreciated!

    Would you say that the recurrence rate for non-mesh repairs (my hernial is small and I do not have a weight problem) is significantly higher or slightly higher?

    Also, any thoughts on whether core abdominal exercises can keep symptoms of an exiting inguinal hernia in check?

    Thank you again.

  • drtowfigh

    December 17, 2016 at 4:49 pm

    Inguinal hernia – pls help with advice

    You’ve done an excellent job researching. I understand it can be difficult to get perspective as to what is important.

    Mesh repair is the gold standard for inguinal hernia repair. It provides the best outcome in terms of recurrence and also recovery time.

    Mesh problems can occur. But it’s important to appreciate that chronic pain also exists with non mesh repair.

    Best option is to find a surgeon you trust and follow their recommendation. Best if it’s a hernia surgeon who is facile with lap open and non-mesh repair. In that situation, the surgeon can provide you with whichever option may be best for you. For example, non mesh repair is not a good repair option for certain patients, such as obese with large hernias or strong history of collagen disorder.

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