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Sliding Hernia, Part 1
@Mike M wants to play doctor and claims that Pinto’s recurrence three years ago from an original surgery for a sliding hernia had nothing to do with my painful taxi rides immediately post-op but had all to do with 1) the assumed rare difficulty of sliding hernia and 2) patient irresponsibility. My purpose here is to disabuse him of his false notions and to clarify for Members the actual nature of the sliding hernia, which need not be feared.
Background
Overall, I had a painless surgery and quite pleased with my hospital experience. However there were two difficult post-op aspects in the first four days: immense pain getting out of bed and immense pain walking. After one-day hospital stay, I was discharged but only after requesting crutches. Bumps during my taxi ride back to my hotel were pure agony.Sliding Hernia: Rare?
@Mike M and others designate SH as “rare.” Let’s get a handle on this descriptor: In the European Union, for example, a disease is considered “rare” if it occurs less than 1% than usual (actually less than 5 out of 10, 000) (Kühne, et al. 2021) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796213/.So how often do sliding hernias occur? A recent study of the matter for over 32,000 cases in the Danish national data base, sliding hernia was found 14% of the cases (Bodilsen, Brandsborg, & Friis?Andersen 2022) https://www.researchgate.net/publication/361072275_Recurrence_and_complications_after_sliding_inguinal_hernia_repair. Estimates generally are given around 5% but with much smaller populations. Even if we use a conservative number, sliding hernias can be expected 5 times more than the EU rareness metric. It seems to me that SH would be more properly described as “uncommon” than rare and most surgeons are likely to have experienced SHs.
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3 Replies
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Pinto’s Account
Pinto naively accepted hospital discharge despite that he believed he needed a motorized bed by which it would assist him to get out of bed when needed. Hospital staff could not find any service locally by which he could rent a motorized bed and place it in his hotel room. Even though hospital staff later said his request for crutches for walking was the first time received, they did not have the wherewithal to consider if early hospital discharge was really appropriate. In fact some hernia hospitals, though uncommon, will have their patients stay 3-5 days before discharge. Nearly any surgeon will advice patients after surgery to protect the surgery area by bracing it with their hands or pillow when coughing etc.Pinto believes that although his surgery was made with the best intentions, there must have been some sort of mishap considering he was the first to request crutches and he had so, so agonizing taxi rides immediately after his discharge. Apparently thousands of patients from the same hospital have relatively little trouble leaving the hospital within 48 hours and can amble away painlessly. Given that Pinto followed the surgeons guide for a safe post-op, he believes if he was able to stay in the hospital in a motorized bed for at least three days, recurrence might not have occurred. It might have even proved the surgery was done flawlessly. He subsequently had a successful operation by the same surgeon two years later without any trouble—- without need for crutches or motorized bed.
In conclusion, when making medical critiques we must do so with considered thought so as to avoid hasty claims as well as being mindful of unanalyzed assumptions by which to control bias or prejudice. Sliding hernias are neither rare nor troublesome for the experienced surgeon.
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Sliding Hernia: Reason for Pinto’s Recurrence
As we have seen, SH is neither so rare nor troublesome for the skilled surgeon. More importantly SHs can have nearly the same prognosis as that for non-SHs. By this view Mike M made a hasty claim in attributing Pinto’s reccurence to the presumed difficulty of SH surgery.He discounted Pinto’s pain experience in his taxi ride from the hospital apparently based solely on Mike M himself having an uneventful taxi ride after his own surgery. Because his ride was painless, by Mike M’s reasoning, therefore, Pinto couldn’t have really had any trouble. Again following Mike M’s reasoning, Pinto probably moreover was careless in his subsequent daily living—–for example the mindless lifting of heavy objects too soon before full recovery.
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Sliding Hernia Surgery: Dangerous?
Not according to the American College of Surgeons risk calculations. Someone with a sliding hernia has only a risk of 0.8% chance for serious complications, which is below average surgical risk. https://riskcalculator.facs.org/RiskCalculator/index.jsp
If proper surgical technique is applied, SH outcomes are quite close to those for non-SH surgeries (Komorowski, Moran-Rodriguez, Kazi, & Wysocki, 2012; Piedad, Stoesser, & Wels, 1973; and Ponka & Brush 1978).
So a skilled experienced surgeon should have no trouble in the successful repair of SHs.
[strangely this website blocked my reference links]
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