Watchtful waiting since 2016

[Wim]

I wonder what is the cause an exitign hernia gets incarcerated and needs to be operated.
I am also watching my hernia, but also avoiding pressureon the hernia. I am not a runner because I think that doing that the shock of the intestins could make the hernia bigger. Applying counterpressure on toilet, etc.

The risk is small but nowhere you get info how someone got an incarcerated hernia.
What was that person doing?

[pinto]

@spinotza, my understanding is that in the UK, watchful waiting is greatly pushed for financial reasons by the NHS. Are there specific guidelines by which to know when surgery can be done? From what I read if you use the public system you must wait. I wonder how much patients can know the criteria used for allowing surgery.

[spinotza]

@alephy the doctors are often good surgeons but the advice they give is often not aligned to the latest research on chronic pain and the advantages of non-mesh surgery. In UK NHS can not offer a non-mesh inguinal repair so the doctors would say anything to make you stop thinking about it.

@holeinthewall , you are right. I am searching for the doctor that would operate my hernia when the time comes. I am opting for open non-laparoscopic. I might accept the mesh for bilateral hernia.
In the case of groin hernia losing weight leads to opposite effects: less pain because there is less pressure on the hernia, less risks of growth and I think less risk of incarceration. I know I’ve been thinking a lot about my hernia but it somehow led to a better life: I appreciated every activity more, I became in general a more careful person and I can’t say I missed out on anything except for contact sports which I was never into.

@pinto – my hernia is of course reducible. I would have surgery if it didn’t reduce to nothing when I’m lying down.

• This reply was modified 2 years, 7 months ago by  spinotza.

[pinto]

@spinotza, @holeinthewall, @alephy, thanks for your reports. We often don’t see such, so particularly helpful they are. Are/were your hernias reducible?

[Alephy]

I also had a small abdominal hernia (fat protruding) in the late 90s, operated in 2003. As it was small no mesh was used, and I was back to my routine after 4 to 6 weeks. I think inguinal hernias are probably a different beast altogether, as the location is a lot trickier.

You mention adjusting one’s life style to the hernia: from what I have gathered here this will continue to be the case even after the surgery (for the inguinal hernias at least), as most people tend to adjust to try and avoid recurrences, or the mesh complications (minor or big that they may be) warrant them to do so.
I have also read stories of people going back to contact sports after few weeks from a mesh repair and not even feeling anymore that they had surgery, and there are also examples of professional athletes in the same category: personally I don’t think this is the majority of the cases.

If I started having limiting pain I would definitely have surgery. As for choosing a doctor, this is easier said than done, as I think I would have to travel for that (I very mush wish covid will be behind us if or when that happens).

[HoleintheWall]

I had a small umbilical hernia I waited on. It didn’t cause any issues at all when I was very overweight, but as I lost weight I started to have bowel incarcerations. I decided to have it repaired after I lost more weight, but the more weight I lost the more often I had incarcerations until I wound up in the ER with a strangulated bowel.

I think that scenario is more specific to abdominal wall hernias, but since having it repaired I realized how much time I actually spent thinking about it or adjusting my life around it.

I’m six weeks post-op, open non-mesh repair, and I’m glad it’s over. I’m having intermittent discomfort in the surgery area, but I’m not worrying about it as a potential issue until 3 months out and it seems to be improving.

I would say at least find the surgeon you are going to have do the surgery if you do decide to do it or if you do have issues and need it done asap. But, it sounds like you’re spending a lot of time on your hernia and adjusting around it like I was, so I would say just bite the bullet and get it done.

[Alephy]

I am also on watchful waiting, right inguinal hernia, direct or indirect I am not 100% sure, since end of 2019. I can only see mine when stretching the skin (was told it is small, but who knows?). It is almost non symptomatic (I can feel it at times when exercising a lot, I am 50 and do internal martial arts ie nothing heavy).
I have seen doctors who clearly had not my interest at heart, as they repeated the same lines that you usually hear from surgeons who want to operate on you, that is: it will get bigger, watchful waiting is not recommended anymore, there is a risk it incarcerates and can be fatal, the mesh is inert and whenever there are problems it is because the surgeon was not an hernia expert. One even said that the hernia on the right will cause one on the left, while telling me how good the Bard meshes are, and that I would be back to sports in days…

As per why they would not consider tissue only repairs: oh but those have 50% rate of recurrence, and you will have to stay put for months, and it is not the golden standard….and of course they don’t know how to do them anyway anymore….

When I asked about absorbable meshes I was told (also here on the forum) that their recurrence rate is high (could not find this result in the literature) and that it is only used in special circumstances…

I sometimes think I am good at stumbling into the wrong people’s office….

[Wim]

My hernia dissapears by itself when lying down, when standing up nothing to to but the slightest pressure on the bowl makes it appear.

[HoleintheWall]

From everything I’ve read, the smaller the ventral hernia the more dangerous it is for potential incarceration.

In my case, as I lost weight the hernia sac began to fall completely behind my abdominal wall on occasion; I assume this was because there was less fat mass holding it outside of the defect. It would usually happen overnight and I would wake up with no visible signs of a hernia.

When it fell back inside, within the next 48 hours it would either find it’s way back out, or my intestine would slip into the defect. If I didn’t catch the intestine right away and keep massaging it back in until the hernia sac took it’s place back in the defect, it would swell and become incarcerated. I would also get some abdominal pain or an upset stomach feeling when the sac was behind my abdominal wall. I assume this was from the sac getting mixed up/twisted with my guts.

The incarcerations weren’t a huge deal for me as I learned how to resolve them myself, but for whatever reason the last time it wouldn’t budge. I didn’t have emergency surgery. At the ER they gave me a bunch of morphine, put an ice pack on me for 20 mins, then the doctor jumped in the air and rammed his thumb into my abdomen. That felt nice, lol. I had a scheduled surgery a few weeks later. The surgery report said the defect measured 1.5×2.5cm.

• This reply was modified 2 years, 7 months ago by  HoleintheWall.