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Suggest Treatment For Inquinal Hernia
Question: I have an inquinal hernia on the right side, and am looking for guidance on what, if anything, to do about it? It appeared in mid July, 2014, and I have been wearing a belt that pretty much keeps it "in" (is the proper term "referred"?) I cannot be sure if it stays suppressed for 100% of the time. If I remove the hernia belt it will protrude almost immediately when standing. For about 2 to 3 months (Sept thru Nov) I experienced times of "stomach upset" or at least discomfort high in my abdomen. This comes less frequently now. I never had this before so am concerned that this might indicate situation is or could be worse than I am thinking. Can I continue to live with this, what would be downsides to such a decision, and if surgery is suggested, what procedure, and why, and how can I be sure of doctor's skill and record. I am sensitive about this because I lost my bladder due to inexperienced doctor that couldn't entertain the idea of swollen ankles due to urine retention and not vascular or bad heart.
My age is 72, ht 6'-3, wt 186 lbs, and am try to keep fit through doing parts of series one of Ashtanga Yoga, semi regularly, so believe that my stomach area has fairly good muscle tone with maybe a pinch of fat. My thought is the hernia was caused by straining to have a bowel movement -- perhaps trying too hard to stay "regular". I say perhaps because I did do some awkward lifting of a large computer in its shipping crate about 2 weeks prior to the hernai appearing. The crate weighed about 100 to 110 lbs; my arms just barely reached across the top of the crate and down the sides to grip the bottom, and I carried it from the trunk of car walking it maybe 50 feet or so into a first floor apartment.
Thank you for suggestions and guidance.
My age is 72, ht 6'-3, wt 186 lbs, and am try to keep fit through doing parts of series one of Ashtanga Yoga, semi regularly, so believe that my stomach area has fairly good muscle tone with maybe a pinch of fat. My thought is the hernia was caused by straining to have a bowel movement -- perhaps trying too hard to stay "regular". I say perhaps because I did do some awkward lifting of a large computer in its shipping crate about 2 weeks prior to the hernai appearing. The crate weighed about 100 to 110 lbs; my arms just barely reached across the top of the crate and down the sides to grip the bottom, and I carried it from the trunk of car walking it maybe 50 feet or so into a first floor apartment.
Thank you for suggestions and guidance.
Brief Answer:
Hernia Surgery is a better choice when you are fit.
Detailed Answer:
Hi.
Thanks for your query and an elucidate history and Medications tried.
Also explored and read the link you have given , thanks for it too.
To recapitulate:
72 years male- suffering from right inguinal hernia noticed since mid-July 2014. - using hernia belt - protrudes on standing after belt is removed - Sept through Nov stomach upsets off an on and worried about may be due to history of colon cancer in family -practices Ashtang Yoga- fairly good muscle tone - thinks straining at bowel movements as a cause - initiated by lifting and carrying computer
# Concerns : stomach upset - decision about surgery - downsides of not doing it - If yes- what procedure / why / sure about Doctor's skill and record - ( lost bladder )
Sir, I can very well understand your concerns and then opine as truthfully as I can. Please feel free to ask for more if you need to and if you feel there is any gap-of-communication. I did the above homework for not missing any points.
First of all, you can continue to live with this. If the size is not large, if the neck of the sack is not too small to admit the bowel (to cause obstruction as a potential risk), there will not be any problem. But the hernia tends to grow larger in dimensions, with time the fitness for the surgery and anesthesia is reduced, There is always a tension in mind what can happen in future (about hernia and other issues related to the body). Use of the hernia belt tends to cause irritation at the neck of the sac causing surgery a bit difficult. Belt is advised in only those patients where the surgery is contraindicated due to some medical reasons (making surgery risky).
Choice of Surgery:
The personal choices of all the Surgeons would be different depending upon many factors.
Since you have not provided the history, I take that you are medically fit without any cardiac or blood sugar issues.
Some centers advocate Laparoscopic approach, some would prefer open approach.
My opinion would be to go for an open approach as you have already used hernia belt. This is an easy, most acceptable, easy to carry on. The procedure is standard an all the cases, viz. Herniotomy- sepearate the sac, see nothing attached from within - tie the neck and do mesh repair.
Well, the skill and the record can be known by talking to the people who have underwent such a surgery. A local research would enable you to find this out. The Surgeon with least rate of complications and recurrence is to be chosen from. Hernia surgery is by and far one if the commonest surgeries done. So it is going to be an easy research for you.
I hope this answer helps you in a good decision making. Please feel free to ask for more or if you need further clarifications if you feel there is a gap of communication.
Hernia Surgery is a better choice when you are fit.
Detailed Answer:
Hi.
Thanks for your query and an elucidate history and Medications tried.
Also explored and read the link you have given , thanks for it too.
To recapitulate:
72 years male- suffering from right inguinal hernia noticed since mid-July 2014. - using hernia belt - protrudes on standing after belt is removed - Sept through Nov stomach upsets off an on and worried about may be due to history of colon cancer in family -practices Ashtang Yoga- fairly good muscle tone - thinks straining at bowel movements as a cause - initiated by lifting and carrying computer
# Concerns : stomach upset - decision about surgery - downsides of not doing it - If yes- what procedure / why / sure about Doctor's skill and record - ( lost bladder )
Sir, I can very well understand your concerns and then opine as truthfully as I can. Please feel free to ask for more if you need to and if you feel there is any gap-of-communication. I did the above homework for not missing any points.
First of all, you can continue to live with this. If the size is not large, if the neck of the sack is not too small to admit the bowel (to cause obstruction as a potential risk), there will not be any problem. But the hernia tends to grow larger in dimensions, with time the fitness for the surgery and anesthesia is reduced, There is always a tension in mind what can happen in future (about hernia and other issues related to the body). Use of the hernia belt tends to cause irritation at the neck of the sac causing surgery a bit difficult. Belt is advised in only those patients where the surgery is contraindicated due to some medical reasons (making surgery risky).
Choice of Surgery:
The personal choices of all the Surgeons would be different depending upon many factors.
Since you have not provided the history, I take that you are medically fit without any cardiac or blood sugar issues.
Some centers advocate Laparoscopic approach, some would prefer open approach.
My opinion would be to go for an open approach as you have already used hernia belt. This is an easy, most acceptable, easy to carry on. The procedure is standard an all the cases, viz. Herniotomy- sepearate the sac, see nothing attached from within - tie the neck and do mesh repair.
Well, the skill and the record can be known by talking to the people who have underwent such a surgery. A local research would enable you to find this out. The Surgeon with least rate of complications and recurrence is to be chosen from. Hernia surgery is by and far one if the commonest surgeries done. So it is going to be an easy research for you.
I hope this answer helps you in a good decision making. Please feel free to ask for more or if you need further clarifications if you feel there is a gap of communication.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Follow Information & Questions:
1. Info: I have no blood sugar issues. As for other blood/cardiac issues, I may have a tendency to develop blood clots after surgery. This happened after my surgery on the infected knee in 2005, and it caused me to need to take blood thinners for some time, causing bleeding into the knee area that would have been detrimental to the cartilage. To head that off, I had a “blood clot “filter” placed in the large vein coming out of the leg, above the juncture with similar vein from other leg, and then was taken off blood thinner. Following that, another knee surgery was performed to clear scar tissue and blood in the knee.
So, blood clotting would be a concern.
Size of Hernia presently is 1.5 in. wide x 2.5 to 3. in. vertical, or 3.8 cm x 6.4 to 7.5 cm.
2. Other concern: Things that can go wrong causing pelvic pain or nerve pain in the area, Sewing split vs use of mesh pro and con, and how long the “fix” lasts. Would not want to require another surgery in ten or fifteen years, should I be blest to live so long. (A few years ago using mesh caused many problems.)
Questions:
1. Could you elaborate on reasoning behind recommendation of surgical procedure: open vs laparascopic, Mesh or no mesh, and do you have any knowledge about another approach known as the Desarda Technique using no mesh and done by a Dr. Desarda in India?
A description of this technique for non-medical and medical persons is available on internet at: http://www.desarda.com/operation-technique (Accessed July 31, 2014) Does anyone in U.S. use this technique?
How does use of hernia belt affect decision of open vs laparoscopic procedure?
2. Are there differences in complications and expected duration and conditions of successful fix duration?
Brief Answer:
No differences ...
Detailed Answer:
Hi,
Thanks for your follow information and questions:
Good to know that you are not diabetic.
As for the tendency to develop blood clots, its consequences in the past may not occur this time. There would have been some other associated problem like septicemia or so due to septic arthritis in 2005.
For the nerve pain : all the surgeons keep this mind to separate and save the nerves. If it is not caught in the stitches or so, there will not be any problem unless they are entrapped into the scar tissue. Scar tissue will eventually occur whatever type of surgery is done.
Pro and cons: sewing split vs mesh:
As per our experience and the data and discussion over the years through conferences and interaction among all the surgeons, there is not much of a difference.
The mesh is a foreign body and has only a problem if the infection develops. With the advent of the most aspetic precautions, the chances of infection almost negligible. It has its own strength and gives the best chance of a cure.
Fix: With the size of the hernia you have mentioned (3.8 cm x 6.4 to 7.5 cm.) and considering your age of 72 and I would personally prefer you the mesh. Mesh is lifelong. May the almighty bless you a very long and healthy life and with my regards... Mesh is the best option.
Of course we all have been known Dr Desarda's technique and all other ones. Thanks for sharing the link I knew of. This just an alteration of very old technique when free fascial grafts were used in past, the graft here is local with intact supply from the sides. Well, we are not here to discuss about details but this too is promising and he has been using it for long.
You can get a list of Doctors practicing his technique from his website.
As already explained using a particular technique totally depends upon the prerogative of the operating Surgeon, his experiences, failures, successes, expertise for new techniques, equipment, Patients general condition, past history, present co-morbidities, age of the patient, condition of the musculature on surgical exposure and so on.
Open approach, meticulous dissection, hernia excision, putting in a mesh and anchoring it nicely is the most established procedure done all over the world with least recurrence rate.
Hernia belt does cause internal fibrosis which is detrimental to have a smooth dissection.
2. Are there differences in complications and expected duration and conditions of successful fix duration? >>
>> Not really.. The more you think, the more you read on the internet, the more will be confusion. It is my humble request to you to have your Hernia checked by a Surgeon of repute, just follow what he feels the best for you, your hernia (type) and the best approach most suitable for you. This is the best policy.
Certain decisions can be taken only on direct examination by the treating Doctor / Surgeon.
I hope this helps.
Please feel free to ask, if there is a gap-of-communication
Wishing you a very healthy life.
No differences ...
Detailed Answer:
Hi,
Thanks for your follow information and questions:
Good to know that you are not diabetic.
As for the tendency to develop blood clots, its consequences in the past may not occur this time. There would have been some other associated problem like septicemia or so due to septic arthritis in 2005.
For the nerve pain : all the surgeons keep this mind to separate and save the nerves. If it is not caught in the stitches or so, there will not be any problem unless they are entrapped into the scar tissue. Scar tissue will eventually occur whatever type of surgery is done.
Pro and cons: sewing split vs mesh:
As per our experience and the data and discussion over the years through conferences and interaction among all the surgeons, there is not much of a difference.
The mesh is a foreign body and has only a problem if the infection develops. With the advent of the most aspetic precautions, the chances of infection almost negligible. It has its own strength and gives the best chance of a cure.
Fix: With the size of the hernia you have mentioned (3.8 cm x 6.4 to 7.5 cm.) and considering your age of 72 and I would personally prefer you the mesh. Mesh is lifelong. May the almighty bless you a very long and healthy life and with my regards... Mesh is the best option.
Of course we all have been known Dr Desarda's technique and all other ones. Thanks for sharing the link I knew of. This just an alteration of very old technique when free fascial grafts were used in past, the graft here is local with intact supply from the sides. Well, we are not here to discuss about details but this too is promising and he has been using it for long.
You can get a list of Doctors practicing his technique from his website.
As already explained using a particular technique totally depends upon the prerogative of the operating Surgeon, his experiences, failures, successes, expertise for new techniques, equipment, Patients general condition, past history, present co-morbidities, age of the patient, condition of the musculature on surgical exposure and so on.
Open approach, meticulous dissection, hernia excision, putting in a mesh and anchoring it nicely is the most established procedure done all over the world with least recurrence rate.
Hernia belt does cause internal fibrosis which is detrimental to have a smooth dissection.
2. Are there differences in complications and expected duration and conditions of successful fix duration? >>
>> Not really.. The more you think, the more you read on the internet, the more will be confusion. It is my humble request to you to have your Hernia checked by a Surgeon of repute, just follow what he feels the best for you, your hernia (type) and the best approach most suitable for you. This is the best policy.
Certain decisions can be taken only on direct examination by the treating Doctor / Surgeon.
I hope this helps.
Please feel free to ask, if there is a gap-of-communication
Wishing you a very healthy life.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thank you for your responses.
I have one more point to clarify or get advice on.
Earlier, you took my GP's desire for me to have a colonscopy before doing anything surgically with the hernia, thinking "just in case", he did not want an evident colon problem with polyp or other to become evident during hernia surgery. I feel that a colonoscopy is not needed. Neither I or anyone in my family has had any problem with the colon, and in my diet, I avoid beef and lunch meats and sausage, and the nitrates and hormones given these animals, getting protein from plant, fish, and chicken that are ostensibly free range, and fed "organic" feed (who knows???). But feel diet and exercise mostly preclude colon cancer.
A concern before surgery would be my prostate and mostly chronic, continuing UTI, and only intermittently being free from UTI (more "controlled"). Having been diagnosed with prostate cancer twice earlier, once turning out to be atypical cells rather than cancer, and then 8 years later (2008), with approximately 1 mm sq (or round) out of 15 biopsy cores with XXXXXXX score 8 being = to (4+arbitrarily scored 4), since specimen too small for 2nd pattern. Since then, PSA total and free have been in range 3.6 to 6.6, with free PSA in range 20% to 22%, and due for another blood test shortly.
So, my question is do you think either a screening colonoscopy or a prostate biopsy is necessary to check presence of cancer before hernia surgery? (I really do not relish idea of another prostate biopsy.)
Thank you so much for your input
I have one more point to clarify or get advice on.
Earlier, you took my GP's desire for me to have a colonscopy before doing anything surgically with the hernia, thinking "just in case", he did not want an evident colon problem with polyp or other to become evident during hernia surgery. I feel that a colonoscopy is not needed. Neither I or anyone in my family has had any problem with the colon, and in my diet, I avoid beef and lunch meats and sausage, and the nitrates and hormones given these animals, getting protein from plant, fish, and chicken that are ostensibly free range, and fed "organic" feed (who knows???). But feel diet and exercise mostly preclude colon cancer.
A concern before surgery would be my prostate and mostly chronic, continuing UTI, and only intermittently being free from UTI (more "controlled"). Having been diagnosed with prostate cancer twice earlier, once turning out to be atypical cells rather than cancer, and then 8 years later (2008), with approximately 1 mm sq (or round) out of 15 biopsy cores with XXXXXXX score 8 being = to (4+arbitrarily scored 4), since specimen too small for 2nd pattern. Since then, PSA total and free have been in range 3.6 to 6.6, with free PSA in range 20% to 22%, and due for another blood test shortly.
So, my question is do you think either a screening colonoscopy or a prostate biopsy is necessary to check presence of cancer before hernia surgery? (I really do not relish idea of another prostate biopsy.)
Thank you so much for your input
Brief Answer:
CECT may be an option worth considering.
Detailed Answer:
Thanks for your feedback and appreciation.
You really caught me right, Sir.
Well, you have a history noted in the first query (For about 2 to 3 months (Sept thru Nov) I experienced times of "stomach upset" or at least discomfort high in my abdomen.)... and now I have read in detail the recent information you have provided.
I know it is really disgusting to have a colonoscopy and prostate biopsy.
After reading your information carefully, I was just wondering why not to go for the following by a common sense of Medical Practice.
This is my personal opinion and you may please discuss this with your treating Doctors...
A Contrast enhanced CT (CECT) scan of the whole abdomen including the prostate, a virtual colonoscopy can be least troublesome and get an additional information. In only doubtful scenario a further test of real colonoscopy / prostate biopsy can be undertaken.
I hope this is taken positively by your Doctors.
With the advent of the newer CT scan machines this is just possible and gives better results. (helps to rule out the problems your Doctor is thinking of).
So I think a CECT can be a better alternative before going for hernia surgery if your GP or Surgeons think of it. This will be the least troublesome and may give useful information to rule out the worst your GP is thinking about, along with the blood tumor markers (PSA and CEA)
Hernia Surgery can be undertaken without the tests as this is done to avoid its complications.
This is my humble request to you to discuss this in details with your treating Doctors.
Wish you a healthy life and successful Surgery.
Thanks for reading thru'....
CECT may be an option worth considering.
Detailed Answer:
Thanks for your feedback and appreciation.
You really caught me right, Sir.
Well, you have a history noted in the first query (For about 2 to 3 months (Sept thru Nov) I experienced times of "stomach upset" or at least discomfort high in my abdomen.)... and now I have read in detail the recent information you have provided.
I know it is really disgusting to have a colonoscopy and prostate biopsy.
After reading your information carefully, I was just wondering why not to go for the following by a common sense of Medical Practice.
This is my personal opinion and you may please discuss this with your treating Doctors...
A Contrast enhanced CT (CECT) scan of the whole abdomen including the prostate, a virtual colonoscopy can be least troublesome and get an additional information. In only doubtful scenario a further test of real colonoscopy / prostate biopsy can be undertaken.
I hope this is taken positively by your Doctors.
With the advent of the newer CT scan machines this is just possible and gives better results. (helps to rule out the problems your Doctor is thinking of).
So I think a CECT can be a better alternative before going for hernia surgery if your GP or Surgeons think of it. This will be the least troublesome and may give useful information to rule out the worst your GP is thinking about, along with the blood tumor markers (PSA and CEA)
Hernia Surgery can be undertaken without the tests as this is done to avoid its complications.
This is my humble request to you to discuss this in details with your treating Doctors.
Wish you a healthy life and successful Surgery.
Thanks for reading thru'....
Note: For further inquiries on surgery procedure and its risks or complications book an appointment now
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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