drtowfigh
Forum Replies Created
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Yes. There is no consensus among surgoens about non-surgical means to reduce hernia symptoms.
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I don’t agree that for the watchful waiting patient that can be risky. Quite the opposite. That is exactly what I would recommend for the watchful waiting patient.
I am a surgeon who believes that the hernia hole can decrease in size with certain changes in activities, lifestyle. We have seen the same on followup imaging. Remember that in the case of indirect inguinal hernias, the hole is always there for the round ligament (females) or spermatic coed (makes). It’s enlargement of the hole that makes a hernia a clinical diagnosis.
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You will not see such data unless a government entity (US or other) chooses to sponsor it—and there is no exercise regimen that has been validated yet to be used for such a study.
We we do have good population data that shows those who exercise regularly are significantly protected from having inguinal hernias, controlling for BMI. We also know that most exercise does not increase abdominal pressure—that data is there. We also believe that hernias get clinically worse in part from increases in abdominal pressure, though there is no strong data to prove that.
You can extrapolate from these that exercising can reduce hernia as a symptom. Clinically, if you have no inguinal hernia symptoms and your bulge is reduced or gone, then there is little to no indication for repair. You seem to have an issue with the word cure. Maybe remission is a better term?
There are plenty of people with hernias who has no idea they have a hernia—tney would be found on imaging. As surgeons, we don’t offer treatment to them, in general.
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[USER=”2804″]pinto[/USER] Absolutely it’’s possible to reduce the clinical symptoms from a hernia by changing lifestyle and improving core muscle strength. We’ve reviewed this topic here on this Forum. I recommend it to my patients all the time.
[USER=”2813″]GeorgeHirst[/USER] has been living this reality for years. He found a flaw with currently available trusses and only recently took it upon himself to redesign them to meet his needs.
I wouldn’t knock the benefits of core fitness in improving the symptoms of inguinal hernias. We know that asymptomatic or minimally symptomatic hernias can be safely monitored, aka watchful waiting.
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Short answer: no.
Long answer: there are some studies about neural grafting with varying results.
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[USER=”2029″]Good intentions[/USER] that was actually nicely put. Thank you.
The unfortunate reality is that we don’t have Level 1 or Level 2 evidence to support guideline recommendations for mesh-related complications in these Guidelines.
We barely have any Level 3 evidence.
It’s incumbent on us surgeons to get that data out. We are doing it piecemeal. The numbers are low.
Just providing the surgoen’s Viewpoint…
Also, to address the J&J website: I believe that’s a marketing plan by J&J. The goal of the surgeons was to get the publishing in a peer reviewed journal.
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I love hearing that!
Congratulations and thank you! -
First you need the right diagnosis. I am happy to help. Also, there are great surgeons near you. You can search this forum for their names based on location.
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Alloderm is absorbable biologic mesh. Don’t expect to see the mesh inside you after about 8 months. Sounds like you need evaluation of your hernia repair.
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No relationship
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[USER=”2042″]Jnomesh[/USER] I completely agree with you. And it’s so frustrating that change and education/training is such a slow process.
we are in discussion of having a course on mesh complications and how to treat them. I give talks on this, as some others do, and in fact will be discussing it next week at our SAGES meeting, but I think a fully dedicated course is what we need.
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Just to provide some clarity, since I personally know all the authors of HerniaSurge and am familiar with what they went through to get these guidelines published:
– this is a multi-continent effort to update and add to the European Hernia Society guidelines. I believe 3 surgeons were from the US.
– the amount of time and effort that went into this was enormous: years of planning and research, multiple meetings. The surgeons literally sat all in a room, like the United Nations of surgeons, for weeks, painstakingly going through point after point.
– it is costly to make such a valiant effort. Just the travel and accommodations alone can be costly, not to mention the loss of time, effort, and income at the surgeons’ practice.
– most of the surgeons were Europeans. The professors there tend to have a very close relationship with Industry as compared to the US, where our relationship is held more at arm’s length. So, it’s not surprising that most of these experts have a relationship it’s Industry.
– Most expert surgeons spend their time teaching others in courses, etc. these are mostly funded but indistry—there are just very few federally or non-industry-funded courses. And surgeons attending these courses won’t be able to afford paying for the entire course themselves without industry support. As an example, I believe the recent Hernia Compact course cost $50,000, and that’s with all the instructors, including myself, spending their day teaching for free. We taught 20 surgeons.
– the experts are truly well respected and the guidelines are each supported with referenced evidence at high levels. I don’t believe that their relationship with Industry affected their interpretation of the evidence. -
If you had no symptoms for years and now there are similar symptoms as the prior hernia, then most likely diagnosis is a recurrence. I would seek consultation from your surgeon. Imaging may be necessary.
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The guidelines are based on exhaustive research of published data and not just expert opinion.
Also, I’m not sure it’s accurate to say contralateral repair is standard. I’m sure it’s overused.
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The Hernia Compact course was very successful. It was focused toward residents, fellows, and junior practicing surgeons. They were taught open, lap, and robotic surgery techniques, including both mesh and non-mesh options. They had anatomy reviewed, imaging reviewed, and then a hands-on course for the open and robotic techniques with and without mesh.
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Sensitivity means it is more likely to correctly identify a hernia if it is is there. Can’t say it’s a clearer picture. There is more soft tissue detail.
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As far as we know, fixing one side does not adversely affect the progression of a hernia on the other side.
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As you may know, most surgical societies are poor and/or struggling to stay afloat financially. Making presentations publicly available is costly. We have looked into various avenues of doing so and just can’t afford to do so. Videotaping is super costly. Live-streaming is even more costly. The society does not own the presentations, so each surgeon must agree to provide them publicly.
It it was quite an amazing meeting this past year.
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Thank you for using and contributing to HerniaTalk!
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[USER=”2029″]Good intentions[/USER] you have mixed the mission of the AHS with the AHS Foundation.
I believe the Hernia Compact course was funded by 2 companies in efforts to help subsidize the registration fee charged from the residents, fellows, and junior practicing surgeons who signed up for the course.