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Surgeons with hernias – what would they do?
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Very interesting to see the survey among surgeons. We need to remember that all the respondents were lap surgeons and the hypothetical condition was a minimally symptomatic hernia. Yet if memory serves me, those choosing surgery all chose lap. Very curious! Not only they would not wait but they would rush to have lap. How was the survey conducted? Within a conference of lap surgery or within the privacy of one’s home? Even hernia surgeons are not immune from social influences, so the survey results are only as good as the method employed. [Game changer: meaning of “minimally symptomatic hernia.” If that translates to small hernia hole, then absolutely immediate surgery would be called for, as small herniae have much higher chance of incarceration. Again another concern about method.]
GoodIntentions makes a worthwhile point: some surgeons oversell surgery. I echo his report: surgeons I spoke with pushed rushing to surgery while at least one internist told me I need not fear incarceration, that I was not in a dangerous condition.
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Most studies show surgeons are less likely to choose surgical options (for anything, not just hernia) than the average person. We know risks occur and are often willing to delay risk potentials.
If surgeons are promoting early or urgent elective inguinal hernia repairs, that’s not supported by level 1 evidence.
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quote ajm222:Most surprising to me was the waiting part. It was my understanding that if you’re going to bother getting a repair at all, the sooner the better.Yes, it doesn’t seem to fit what most surgeons tell their patients. Very few seem to recommend waiting. The message the patients receive is that bad things can happen, emergency rooms and death, so you should get it fixed soon.
Also, I didn’t mean to give the impression that I agree with what the surgeons would do. I posted to show the mismatch with what is recommended to the public, but also how their other thoughts follow the Guidelines. The typical surgeon today will recommend lap with “mesh”. But, in the end, the surgeons know as much as us, which is not much, about what really works well to avoid chronic pain, which appears to be at about a 10 – 30% level, today.
A follow-up survey that might be very informative would be one asking surgeons who had had their own hernias repaired to report on the results. How do they feel about it? Would they recommend what they got to friends and family? Not talking from the Guidelines but from something that they’ve actually experienced.
The pool of respondents would be small but the answers should be of very high quality, a surgeon’s perspective, from inside. With anonymity the answers could be very honest. With presentation at the bigger meetings like this one, their thoughts could spread much farther. Everybody wins.
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quote drtowfigh:Interesting answers, right?
The data shows risk of watchful waiting to be 0.18%/yr and most of us (should) include that as part of our consent to the patient. Or, it’s safe to wait.
We also know that that the risk of complications, including chronic pain is lowest with laparoscopic repair with mesh done by an expert surgeon. That includes comparators of open with mesh and without mesh.
We also know that surgeon skill is directly related to outcome, including recurrence and chronic pain.
Most surprising to me was the waiting part. It was my understanding that if you’re going to bother getting a repair at all, the sooner the better.
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Interesting answers, right?
The data shows risk of watchful waiting to be 0.18%/yr and most of us (should) include that as part of our consent to the patient. Or, it’s safe to wait.
We also know that that the risk of complications, including chronic pain is lowest with laparoscopic repair with mesh done by an expert surgeon. That includes comparators of open with mesh and without mesh.
We also know that surgeon skill is directly related to outcome, including recurrence and chronic pain.
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