Thought my hernia was direct, now thinking otherwise…

[Alephy]

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…

[drtowfigh]

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

[UhOh!]

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?

[drtowfigh]

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

[UhOh!]

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).

[drtowfigh]

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.

[UhOh!]

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 3 years, 10 months ago by  UhOh!.

[drtowfigh]

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.

[UhOh!]

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.

[drtowfigh]

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.