This may be a stupid question…

[UhOh!]

Thank you, Dr. Kang! Your input is always appreciated, as is your knowledge.

[drkang]

quote UhOh!:

The hernia I have is very easily reducible, but every time I do, it sort of slides against (what I assume is) the pubic bone; could rubbing against a hard surface like that cause the sac, or whatever layer is between the sac and bone, to itself develop a hole (like a hernia within a hernia, lol)?

A newly formed hernia sac is so thin and weak that it is easily torn during the operation. But with time it becomes larger and also thicker. And any irritation including rubbing I think also makes the sac wall thicker. That is how our body usually responds. So do not worry about any chance of hole formation as a result of rubbing against the hard structure.

[UhOh!]

Interesting, thanks. I tend to doubt I have a significant risk of the extension of the peritoneum by the hernia itself would be great enough to cause a thinning; mine just isn’t that big. My concern was more about whether rubbing against other surfaces would cause that but your hypothesis makes sense.

Also interesting about the degradation seen upon mesh removal. Is that primarily on lap repairs, done from the inside, where the peritoneum has the opportunity to stick to the mesh (vs. open repair where mesh sits atop/in between muscle and that is the surface most likely to adhere to the mesh?

[Good intentions]

My understanding of the hernia sac is that the peritoneum layer can actually thin out as it gets extended until it’s almost gone. A surgeon told me that. But, I’m fairly certain that the body will try to maintain that layer of peritoneum so will be working to heal it back to its original function. After mesh removal much of the peritoneum has been disrupted and the intestines are sitting on raw damaged tissue. Eventually new peritoneum grows in, as I understand things. I don’t know if it ever gets back to full coverage but the process continues for years I’m sure. The genetic code persists.

Another interesting fact that I’ve learned is that omentum, which I had thought of as just a gooey material that filled the space around the intestines, is actually a fold of the peritoneum. And it’s fairly active, it can get cancerous. The biology of the “bag” that the guts sit in is actually pretty complex.

The short answer might be that even if a hole was created it probably wouldn’t matter much. Another thought would be that hardness doesn’t really matter if the material can just slide by. If you consider the spermatic cord’s path and how it passes over a very hard area but never seems to get injured it might give another perspective.