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Surgeon claims no surgery needed on direct inguinal hernia — quite confused
Good evening,
I recently had a CT scan done to reveal the cause of some consistent discomfort from where a left direct inguinal hernia laparoscopic surgery was done a few years ago. While the CT scan showed nothing wrong (great news), revealed was a tiny hernia on the opposite side.
The surgeon claimed that, being so small, there is no current need for repair, and that many people go their entire (active, even athletic) lives without really noticing anything. Due to the amount of research I’ve done for my first hernia, this raised a red flag; as far as I know, there are no hernias that repair themselves, and there is usually a trend towards them getting worse. I’d run for a second opinion with the intent on setting up a surgery date … except, the surgeon who stated this is a very well-known hernia repair surgeon who deals with problematic meshes as well. Their name is used quite often on this site as someone with a high degree of skill and professionalism in this field.
So, I’d like to know — what does everyone else think of this? I’m having difficulty reconciling what I know to be true (that there probably should be surgery) and the opposite information being given to me by a surgeon who is highly respected and counseled in these matters.
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4 Replies
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Incidental asymptomatic hernia… I wouldn’t dream of touching it.
If it doesn’t bother you or impact your life in any way… that’s a tough thing to “improvove upon.”
With the risk of harm being clearly established now I would argue it’s flirting with malpractice to even touch it.
Well I’m sure a surgeon could make a creative case using your logic that hernia is a progressive disease, at some point in the distant future it could become symptomatic, and this is causing the patient anxiety over when that day might, if ever, occur…
But it’s a stretch.
Anyone who is quick to offer you surgery as quick as you are asking for it you should run from.
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I wouldn’t even dream of having surgery done on an asymptomatic or minimally symptomatic hernia. Watchful waiting is the standard recommendation in such cases these days. I would just wait and see if anything alarming happens.
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I think that you need more information than “tiny direct hernia”. He might mean that he sees a bulge, and that the bulge will probably not get bigger. Surgery has its own risks. The risk/reward ratio is what’s important. If he is well known and has done many lap mesh repairs then he probably thinks, or knows, that implanting more mesh for a tiny hernia might cause more problems than the small one that it fixes. He knows that you probably have a sensitivity to mesh, because you have discomfort around a mesh repair.
What’s interesting, but common, is that nothing was seen on the mesh repair side to explain the discomfort. “Nothing wrong”. Yet there is constant discomfort. Does that make sense? What did he recommend to deal with the discomfort?
If he offered to do the same surgery for the tiny hernia as what he did for the uncomfortable repair would you take it? Would you be okay with the same consistent discomfort on both sides? He’s probably making the decision for you, and himself.
There is nothing wrong with getting a second opinion. But if you go to another lap mesh surgeon they will probably assume that they can do a better job than the other guy. That’s what I found when I talked to surgeons about mesh problems. So choose your second opinion expert carefully.
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You mentioned “discomfort”. Was that from the tiny hernia or the previous repair site?
If you’re not having any pain from the tiny one, there is no reason for surgery. Eventually it will probably get worse depending on your age and activities. I’ve gone for over 15 years with a large inguinal hernia that is easily reduced and rarely causes pain. I would not have it fixed except that I developed another on the other side that is painful, so I will have both fixed at the same time.
I think it was JAMA that did a comprehensive study on this issue and advised watchful waiting if no symptoms.
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