Thought my hernia was direct, now thinking otherwise…

Hernia Discussion Forums Hernia Discussion Thought my hernia was direct, now thinking otherwise…

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    • #28696
      UhOh!
      Participant

      So, I’d always believed I had a direct hernia since it seemed to extend “outward,” was always reducible and would immediately come back out after reduction (if standing).

      However, recently, it appears to have dropped a bit “lower” with the tip of the sac starting to enter the top of the scrotum. That now makes me think that it’s indirect.

      When I thought my hernia was direct, I was just going to leave it alone until it bothered me. However, I’m now rethinking since it going into the scrotum worries me a bit.

      Anybody know of a surgeon in the midwest (as close to Chicago as possible) experienced with Marcy repairs? That would be my first choice. Seems like it has a reasonable success rate in the right hands and also the least potential for complications (and leaves the most options if indeed there is a recurrence).

      Only doc I have heard of so far on here that does that type is Dr. Brown, and I’m not looking to travel to CA at the moment. If anyone has recommendations it would be appreciated!

    • #28697
      drtowfigh
      Keymaster

      The Marcy repair is not indicated for adult males.

      I recommend you find a surgeon who can perform a variety of repairs and have them guide you as to their recommendations rather than choosing a repair type that may not be suitable or appropriate for your need.

    • #28698
      UhOh!
      Participant

      What other pure tissue repair, more appropriate for an adult male, would involve the least amount of cutting/sewing?

      Otherwise, what’s currently happening with fully absorbable mesh on indirect hernias? I seem to recall that the one study out there showed about 40% recurrence on direct but near zero on indirect.

    • #28699
      drtowfigh
      Keymaster

      Can’t cherry pick one study. The size of hernia, your anatomy, your medical history and risk factors, surgeon experience, etc, all factor in on what is considered best repair for you.

    • #28700
      UhOh!
      Participant

      Thanks, and of course that will determine treatment course. However since different surgeons seem to specialize in different repair types, I want to try and have a clearer idea of exactly what to search for.

      Also, out of curiosity, why is Marcy contraindicated for an adult male? Is it not considered strong enough?

      • This reply was modified 1 month ago by UhOh!.
    • #28702
      drtowfigh
      Keymaster

      Marcy is not a reconstruction, rather a simple closure of a hole. It is considered a valid repair only for indirect hernias and only in children and some women, but not adult males. The repair depends on tissue integrity, which has clearly failed if you have an enlarging indirect inguinal hernia. Patients, in particular males, with inguinal hernias are considered to have abnormal tissue integrity (eg, collagen, MMP, etc) and require a reconstruction of the groin to release tension in the area and redistribute it.

    • #28703
      UhOh!
      Participant

      Got it, thanks. And I suppose that there’s no way to assess tissue integrity until the actual operation commences?

      My (layman’s) theory about how I got it was just putting more pressure on the area than it was designed to handle – I’m a recreational lifter and for a couple of years used a lifting belt. When using it properly (to maximize intra-abdominal pressure) it seems like a perfect storm: pressure increased beyond what one could create on their own, with the belt stopping just above the groin (no protection there). I still lift but have since stopped using the belt.

      I’ve also noticed something else interesting: When exercising, prior to doing anything core-engaging (push-ups, planks) I will reduce it/engage the surrounding abdominals to “hold it in” and sometimes it stays in for at least a few hours after. That only happens after working out, though. I don’t know if that says anything at all about surrounding tissue integrity…

      FWIW, and of course I’m no expert, it doesn’t seem that the defect is enlarging, rather that the hernia sac and gravity are conspiring (since it’s gotten “longer” but if anything protrudes outward less than it has in past).

    • #28704
      drtowfigh
      Keymaster

      The fact that you have a hernia implies there is a lack of mature strong collagen. It’s not a visual or tactile thing.

    • #28706
      UhOh!
      Participant

      I suppose this brings up an entirely separate question: Post-repair, regardless of type, is there anything one can reliably do to improve collagen quality and reduce chances of recurrence/new hernias?

    • #28707
      drtowfigh
      Keymaster

      as far as we know, there is no way to modify your collagen status in the groin.

    • #28717
      Alephy
      Participant

      When choosing a doctor, try and go for one that uses all the techniques available. It happened to me to consult with one who in his website mentioned Shouldice and non mesh procedures, only to be told during the visit that he will choose a technique which he is proficient/skilled with, which turned out to be mesh (he did not perform Shouldice etc any more and would not use them).
      This is basically the problem: going for an expert that can tailor the surgery to your needs might just not be enough, if the expert is only expert on certain procedures….

      As far as I could read about collagen, nobody knows yet how this problem evolves (some evidence suggests it is in the dna) or whether it can mitigated in any way (e.g. with a diet change, although I would not be surprised if this was possible) and there is controversy on the supplements (although some say there is some evidence that they are beneficial in general against bone narrowing when ageing for instance); I think it was mentioned before on the forum that when taken as pills they might not even make it into the body…having said this, as long as they are not super expensive I myself am thinking to try them…

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