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  • Not sure what to do – surgery or not

    Posted by norton on January 9, 2017 at 9:25 pm

    Hello

    I’m fairly new on the forum here, and would really appreciate some advice. I learned recently that I have a small inguinal hernia (about 2.5 cm). I’ve done a little reading here and elsewhere about hernia surgery, and must admit, that while I’d like to get this fixed, I’m quite scared of what I read concerning the possibility that chronic pain could result from the surgery. So my question to everyone here whose knowledge and judgment certainly goes well beyond mine … what would you do if you were me?

    Here’s my situation: I’m 67 years old and in good physical shape, having been a distance runner for the past two decades. I’m not on any medications whatsoever. My family doctor has described my hernia as “small”. He feels I really don’t need to do anything about it at this time. A second doctor – a surgeon with lots of experience with hernias – has also stated than an option is definitely watchful waiting. He stated that the risk of anything serious developing was quite small (though not non-existent). He did though, that “these things don’t get better on their own” and most people eventually (with ten years or so) end up getting surgery.

    I did search around for a surgeon who was experienced with non-mesh repairs and this doctor certainly is. He does both types, but is an advocate for, and experienced with the Shouldice-type of repair. I do understand that the recurrence rate is a little higher when mesh is not used, and I would accept that because I just want to avoid mesh. But in terms of chronic pain issues after surgery he has indicated that as many as 30% of people getting the surgery, can possibly have chronic pain issues. (I read different statistics in different places, but if this number is anywhere near accurate, this really concerns me. Maybe I’ve also scared myself by reading some of the post-surgery stories posted online.)

    Currently, my hernia is only mildly symptomatic. I am aware of it, expecially at the end of the day when I have a few sensations (not exactly pain, but some different feelings there). It’s probably more of an issue mentally than physically for me, because it’s on my mind.

    The other factor for me is that I currently have a shoulder tendonosis issue that causes fairly constant, though low-level discomfort for me. This is sometimes a challenge for me to deal with, and I certainly don’t want to add to this with any chronic pain that might result from hernia surgery.

    I should add that I’ve also read about exercises that could possibly resolve such hernias, or at least keep symptoms from becoming worse. I’ve already started some of these, and am prepared to commit fully to these if they have potential.

    Anyway, I know there aren’t any “right” answers, but I would really appreciate any thoughts concerning what you would do if you were in my place.

    I do have a surgery date schedule in about a month, but I’m really wondering now, whether I want to go through with it, or wait.

    Again, thanks in advance for any thoughts or advice! I just don’t know what to do.

    Norton

    MikeL replied 7 years, 1 month ago 4 Members · 5 Replies
  • 5 Replies
  • Beenthere

    Member
    January 23, 2017 at 4:20 pm

    Not sure what to do – surgery or not

    Hi Norton,

    I had a hernia that a quote expert tried to repair and things went very south and ruined 2 years of my health and enjoyment. It looks like you might have read some of my posts. My quote top surgeon and hospital had a known 25% post surgical pain issue after 1 year. It was published as a medical study and I think I gave the link here once.

    I also recommend the book Unaccountable as a starting point but it seems no one wants to take the time to read it.

    Again if I was told of the 25 to over 30 percent post surgical pain maybe for the rest of my life or a 10-20 percent reoccurrence rate and at your age I would go to a tissue specialist.

    Good luck on you decision.

  • MikeL

    Member
    January 10, 2017 at 9:07 pm

    Not sure what to do – surgery or not

    Dear Norton,

    I think that the best way to study statistics is to read studies outside of this forum. You may find out that “the grass is not so green” even in case of pure tissue repair. Where mesh is definitely blamed is occurencies of deformed mesh/ball mesh, nerve entrapment, adhesions to other parts of abdomen. These cases are not considered as so frequent statistically. Nerve entrapment by either scar tissue or mesh in many cases is successfully managed by few steroid injections, etc… As of pure tissue repair, overtightening of the torn muscle that is pulled together is menioned as another case of chronic pain. The advantage of the no mesh repair, in my opinion, is not mainly because of eliminating any nerve entrapment or balled mesh causes. It is rather the possible corrective action is more straight forward. Literature mentions ischemic pain in the region tighten by sutures with no mesh. If the pain source will be from there and will not respont to non-surgical pain management then redo surgery will use mesh. In other words no mesh removal is involved as corrective action. Now, tightness in the operated area is affected by skills of the surgeon and how healthy your tissues are. I think the younger the person the stronger and more flexible muscles are. However, if you are in a good shape it is very possible that you belong to this category as well.
    Please read these articles. You may find the stats you are looking for.

    https://www.practicalpainmanagement.com/causes-postoperative-pain-following-inguinal-hernia-repair-what-literature-shows?page=0,1

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421159/

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2075594/

    In my opinion the healhier the torn tissue, I mean smaller tear and less painful preoperative conditions, the better expected outcome is. Why should you wait for pain and other symptoms? Earlier you address the problem easier the repair on you is supposed to be. You mentioned that hernia is of a certain size. It does not automatically mean that length of applied sutures will be the same. It will depend on how bad and weak surrounding tissues will look alike.

    I think that medical hernia society should weight and re-estimate surgical approaches based on patient segmentation analysis. More robots entering operative room potentially downgrading surgeon skills and narrowing number of offered solutions. US surgeons lost capabilities of hernia pure tissue repair to large extent (I mean it is hard to find them), many offer lap repair and try to avoid open repair with mesh. Are universities teaching surgeons to perform this type of surgeries? What to be expected in 10 years from now when the old school doctors retire?

  • goldenmsc

    Member
    January 10, 2017 at 8:38 pm

    Not sure what to do – surgery or not

    Norton,

    Im in the same situation and have drawn the same conclusion you have.
    Would prefer non-mesh tissue repair.

    Is it best to potentially risk quality of life and fix it or try to live with it and even then have to give something up.

    I was also told 30% chance of chronic long term pain and that may be too low chance.
    Some pain could be debilitating.
    Mesh — who will react to or reject it .. like playing russian roulette.
    Something could happen with sutures too.
    Who will react this way .. nobody knows.

  • norton

    Member
    January 10, 2017 at 1:59 pm

    Not sure what to do – surgery or not

    Thanks for your response and thoughts, MikeL. Appreciated!

    I would definitely like to have my hernia repaired. Though it’s only mildly symptomatic at the moment, it’s a worry and almost always on my mind. As I mentioned I have a date for surgery in about a month. However I’m really undecided and nervous about hernia surgery given what I understand is the rate (up to 30%, if some of the accounts are accurate) of chronic pain after surgery. I think I could accept say, a 5 or 10 percent occurrence or chronic pain, but 30 percent?

    I’ve enjoyed running, but am quite prepared to say goodbye to it if necessary, or if it would be too risky. It’s not a priority. Overall quality of life is, I think, more important.

    Perhaps, as you say, those who’ve had pain issues are greatly overrepresented on forums. Still, the stories and some of the statistics I read … I don’t know if I’m overblowing this fear, but quite frankly, it’s the real issue I’m wrestling with as I consider whether or not to proceed with the surgery.

    Concerning the type of surgery if I were to proceed, my preference if it’s possible, would be for a non-mesh approach. It was my understanding that a non-mesh (pure tissue) approach generally led to fewer post surgery complications. But I admit to being unclear about this. It just seems to me that regardless of the approach, there is real potential in any inguinal hernia surgery for nerve damage or entrapment.

    I do understand that a pure tissue approach means more pain initially, as well as longer recovery (and slightly higher recurrence rate). I’d be prepared to accept that. But what I’m really not clear about is whether there is any evidence (statistically or anecdotally ) or support for a non-mesh approach generally resulting in less chronic pain.

    I’m guessing I’m not alone in wrestling with this question of whether to have the surgery or to wait. I think I will schedule another consultation with the surgeon to ask some more questions, and hopefully that will help.

    Thank you again for the reply, and if anyone has any other thoughts or perspectives on this, these would certainly be appreciated!

    Norton

  • MikeL

    Member
    January 9, 2017 at 10:58 pm

    Not sure what to do – surgery or not

    If I would want to continue running at this age I would definitely take care of the hernia. If the doctor thinks you are a good candidate for pure tissue repair then you probably are… Not everyone can qualify for this type of surgery. Overweight people may not handle this very well and get recurrent one fairly quickly. As of mesh… You see here a lot of people here in this forum while the reality is that probably 95-98% of population (after hernia repair with mesh) never heard anything about hernia complications… I would recommend to keep in mind the following. Any pure tissue repair is more invasive than mesh repair. You will probably end up with some ischemic region where the sutures will be placed, which is normal. Some mild tight and numb feeling will be there “forever” (not a big deal in my opinion either). Recovery on average is longer and more painful, which is also very normal. Be honest with you, runners primarily experience “horse” type monotonic loads on the groins and get wear because of that rather than twisting or pushing. I would find another good doctor for 2nd opinion who is very proficient with mesh and ask about so called “soft” type mesh that could fit your runner’s goal, although modern lightweight mesh can be great fit. I am not a specialist… In my opinion, mesh would be better option for runner at this age rather than any type of pure tissue repair simply because you do not do moves similar to what gymnasts, figure skaters, soccer and football players do. Those folks may demand pure tissue repair simply because they would want “working” aligned muscles attached together. Open mesh repair – Lichtenstein repair is the golden standard (no lap). However, my advice is to go with your own personal “animal” feeling. You feel safe with no mesh – go for it if the doctor qualified you as a good candidate. Doctor does not want to fail either.

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