Watchful waiting?

[Good intentions]

Also, when doing your research make sure that you distinguish inguinal hernias from the other types. I’ve seen instances where ventral or incisional hernia data is used to talk about inguinal hernias. They are not the same. Incisional hernias are much more problematic.

Good luck.

[Good intentions]

No offense donjack, but it would be foolish to have surgery for an asymptomatic pain-free “hernia”. It’s almost malpractice that your doctor is suggesting it.

The experts agree on watchful waiting, see Twitter link below, and even general surgeons would wait, according to a survey done at one of the big conferences in the recent past (can’t find the link). The probability of pain from a mesh implantation is also agreed by most experts to be 10-15%. Read through some of the posts on the site and you’ll find several from people who had no or very little pain but decided to get surgery to be “safe”.

https://twitter.com/search?q=watchful%20waiting%20hernia&src=typed_query

[Alephy]

For what you know you might not even have an hernia so why risk surgery? Plus once in if they use a mesh they might just put it anyway…

[Alephy]

I would do nothing if I were you!

[donjack]

I am 65 and have been watch/wait for 2 years. Most likely will get labroscopic done at end of this year. I have zero pain or discomfort. Only symptom is left side of my inguinal groin area protrudes about 0.5 inch more out than the right side. Feels just like a layer of fat. can’t feel any bump even when I cough, but doc says he does. doc told me 15 years ago I could have a hernia problem there in my future. Would my 0.5 inch be considered small, medium, large?

• This reply was modified 4 years, 1 month ago by  donjack.

[Colt]

Doc, I wonder are there any new inguinal hernia meshes on the horizon in next few years
That are going to be more acceptable to the human body rather than the ones currently in market,
Another question if a tissue repair fails,(shouldice) can you do another tissue repair or at that point to fix hernia would you have to definitely go back to mesh
To repair, just curious

[drtowfigh]

Watchful waiting has been studied prospectively for up to 10 years. The risk of needing emergency surgery was 0.18% per year. That’s a very low number, and thus watchful waiting is considered safe in men with asymptomatic or minimally symptomatic inguinal hernias.

[Alephy]

I agree with you @Momof4…I really find it disconcerting that so many docs report wrong facts or numbers….what’s wrong with stating what is known and letting the patient know the possible risks? This is incidentally why patients with problems after surgery get angry,at least from what I read here…the other really annoying thing is that some doctors get angry as soon as you start asking too many questions!
Btw about the watchful waiting:one doc told me it’s fine to wait,another that it’s not recommended anymore, yet another that I can certainly wait few months…all this while happily taking my money

[Momof4]

Alephy,
The statement on the UK site is false! While surgeon technique and skill definitely contribute to success it certainly isn’t the only factor when mesh causes problems or fails. I know Dr. Towfigh has said the percentage is small, but some people react to the mesh itself. You can have an allergic reaction or foreign body response (which may be dose dependent). I have had lots of problems with 2 different types of mesh and my surgeries were with top hernia specialists so I’m fairly sure it wasn’t the surgeon. Seems we are finding out that mesh is not inert and does not always behave as predicted. Wish I had known this before I was implanted by a local surgeon, a surgery that was considered “no big deal” was the start of a long nightmare for me. I’m still working with doctors to find a solution that will get me back to “normal”, whatever that is! Haha

[Kablooey]

Alephy,

When I discovered that I had a hernia and was researching my options and learned that Polyproplyene Mesh is not entirely inert as it is often claimed and degrades through oxidation regardless of the “skill” of the surgeon it seemed like a no-brainer to me as a 43 year old who potentially may be around for a few more years to choose a non-mesh approach. I was very fortunate that my “Top Tier” health insurance plan in the US offered thru my employer had a rather high deductible requiring me to pay nearly the same amount as flying abroad and paying for the procedure out of my own pocket. When considering this and the fact that if I were to go with laparoscopic/mesh which was recommended by a top NYC surgeon and had a problem… It would be so much more expensive finding a surgeon to fix it and the consequences could be so devastating: permanent erectile dysfunction? I couldn’t imagine having something in me that may eventually fail and cause complications in a few years or possibly 30 years down the line. Where as the worst case scenario with the non-mesh option would be to have it done again free of charge. Yes, it would be wonderful if every hospital across America offered these procedures but we should be so grateful that there are already more than a handful who can and the wealth of information that is available thru this forum! -Best Regards

[Alephy]

Well, here I am re-evaluating watchful waiting…it seems it is not so easy to get 1) a non mesh surgeon and/or 2) one that is covered by my insurance.
I have been told that the smaller the hernia the better for a non mesh repair: I wish I had been told that one can indeed get a non mesh repair without the surgeon ultimately deciding for a mesh during surgery..

So basically I don’t see the point in getting a mesh now unless it is really an emergency, in which case they will most certainly use a mesh anyway…

The question is: do doctors see or have a feeling how things will change in say 10 years from now?

How much of the long term problems related to the mesh goes down to the skill of the surgeon do you think?
(one site in the UK stated that all the problems with mesh are due to the surgeon not being skilled enough…which goes against my understanding of what could go wrong with the design of the implant itself.material etc etc)

[pinto]

My own dentist needed emergency IH repair. I assume a dentist has infinitely more access to a local medical community and medical awareness than many of us. He likely did some watchful waiting. Alex, you are moving in the right direction. Make sure you feel right with your ultimate decision. Good luck.

[UhOh!]

quote Alephy:

[USER=”1391″]UhOh![/USER] do you have a direct or indirect hernia? The US report in my case also mentions fat and small intestine…fat from the small intestine? How good is the US in differentiating the type of inguinal hernia btw?

” pure tissue repair involving minimal cutting/sewing “: does this include Shouldice in your opinion? from what I have read the Shouldice procedure is quite “heavy”

I’m honestly not sure, the US report didn’t indicate. I’ve always assumed direct because of how it “behaves” (seems to bulge “away” from scrotum, always quick to go “in” when I lie down and come back “out” when I stand, easy to manually reduce whether sitting, laying or standing), but that’s hardly a medical diagnosis.

US did indicate the size of the hernia defect in centimeters, which I took as an indication that it was direct, but again, that’s not exactly a medical opinion…

[Alephy]

Yes I agree with you. I will be seeing some doctor(s) next week, and have already contacted some others in Europe…at the very least I have some options (all of them expensive to a certain degree)…I have also a scheduled ct scan and surgery discussion end of February but if I find the right surgeon before I might go for it and not wait….definitely the discomfort has increased, and although the odds of an emergency are in my favour, I just want it controlled so I can eventually go back to my previous physical activity…also I have had onsets of back pain which I think are related to the hernia somehow..

[pinto]

Alex,

I highly recommend that you forget watchful waiting. Any worsening of your condition is very unlikely to be reversed. The worse the condition, the less successful repair will be. Most troubling is if you ever need emergency surgery when you are very unlikely to even know the surgeon let alone choose a method or competent surgeon. (I talked with enough general surgeons that convinced me about the latter point.)
Good luck.

[Alephy]

[USER=”2029″]Good intentions[/USER] Thanks I have gone through the post on available meshes…one day I will try and ponder on what clicks in doctors brains that makes them see A but NOT see B (long term pain), it cannot just be money…

[Alephy]

[USER=”1391″]UhOh![/USER] do you have a direct or indirect hernia? The US report in my case also mentions fat and small intestine…fat from the small intestine? How good is the US in differentiating the type of inguinal hernia btw?

” pure tissue repair involving minimal cutting/sewing “: does this include Shouldice in your opinion? from what I have read the Shouldice procedure is quite “heavy”

[UhOh!]

I’ve opted for it thus far and continue to do so. As far as things I’ve had to change:

-No more deadlifts in the gym (but can still squat heavy without issue)
-No pull-ups or climbing in ways that stretch out the whole body
-Use hand to hold hernia in when coughing/sneezing

Occasionally, the bulge will enlarge a bit more than usual (typically when I have upper respiratory tract infection) but it doesn’t seem to do so for more than a day. Pain is rare, and if it happens feels like a mild muscle ache (not nearly as bad as when I pull an actual muscle).

Part of why I’ve felt comfortable waiting is that I, too, had an ultrasound and it showed only fatty tissue in the sac. Had it been intestine, I might have thought more carefully about a repair sooner.

There are two things that would make me consider a repair, besides the obvious strangulation (and I’m guessing one will happen eventually, at some point):

1. Significant increase in size.

2. Local availability of a surgeon performing a pure tissue repair involving minimal cutting/sewing (closest seems to be Dr. Grischkan in OH).

[drtowfigh]

The amount of pain and acceptance of symptoms varies per patient.

[Alephy]

When do you think one should seek surgery instead of waiting? where do you draw the line?(apart from extreme pain, symptoms of strangulation etc)….some pain is acceptable or one should get surgery immediately then?