Hernias

[Mach Turtle]

Hi. I did a search and found nothing relevant, though I can't believe this hasn't been touched on (cough, cough) before.

I did my medical last week and the doctor said I had a near-hernia. He passed me, and said not to worry about it, but of course I am.

I have a "weakness," he said. This pronounced as he felt my abdomenal wall, around my waist, while I coughed on demand.

There's apparently no exercise or anything else I can do except hope for the besr.

I have two small children whom I lift a lot. I am trying to practice good lifting technique.

Is there anything else I can do? Can I improve, or is it just a matter of avoiding further degradation?

[Airbus_a321]

Is there anything else I can do? Can I improve,

- NO !!
thats what my doc told me

[HubNuts]

Inguinal Hernia

I have recently been diagnosed as having an Inguinal hernia, but these are very common and are only a small tear in the abdominal wall muscle, which allows the intestine(s) too sometimes protrude out through the tear and then retreat back in, when excessive flexure occurs in that region.
Condition cannot be improved, what is needed is a simple operation, to repair the hole, and now because of medical procedures and techniques recovery times are vastly improved, as surgeons now use a method called the Tension Free Method too repair damage, using flexible thin mesh like material, which also provides a good framework for muscle stability and tissue growth.

But not too sure if all hernias are treat the same surgically, but if it can be repaired using the knife so too speak then find out, nothing ventured nothing gained...

Good luck

[gingernut]

Never heard of a "near" hernia.

Sounds like he's not quite "near" a diagnosis, may be worth having a chat with your GP.

Loads of different types of hernia, from the cough cough it sounds like the groin is the problem area. I always think of my old knackered bike, with bulging inner tubes bubbling through rips in the tyre side walls.

The procedures for repair are quite straightforward nowadays, and the outcomes are generally good. But don't have a "near" operation.

[Mach Turtle]

Thanks for the replies. He just said he felt a weakness in my abdomenal wall, apparrently somewhere abeam Mr. Happy, when I coughed. I had previously thought of my abdomenal wall as one big weakness.

I cannot feel any obvious anomaly down there. I feel pretty ridiculous groping myself and coughing, though, and so have not searched much.

I guess there's nothing to do until such time as a serious rupture develops, which may or may not happen. It's too bad there are no exercises or other things to do to improve the situation.

If I needed an operation, I would be suspicious of mesh. There seem to be some dodgy types out there, and there are reports that this is one of those areas in which doctors tend to recommend the product of whichever medical device company has feted them best.

Thanks again.

[obgraham]

Originally Posted by Mach Turtle

If I needed an operation, I would be suspicious of mesh. There seem to be some dodgy types out there,

I wouldn't worry. The "tension-free repair" alluded to above usually uses one of a number of types of mesh, and works better than the old Bassini/McVay/OyVey suture methods. If you need to get it fixed, find a good general surgeon, and let him do what he's paid to do.

On the other hand, just because your GP says he feels something odd when he has his fingers around your nether bits doesn't mean you need surgery. If you've no symptoms, carry on a bit, and see how he likes it next year.

[radarman]

Nearly four years since the last post in this thread, so maybe there's some updated information out there. My GP has diagnosed a bilateral inguinal hernia, but I have yet to work my way through the referral system to see a surgeon. While waiting, I've been looking at the www. It seems, that mesh repairs are now the accepted method, but there are also some horror stories of these occasionally causing unbearable and uncurable agony. Has anybody any experience of this op? Are the scare stories the usual internet 'shock horror', or are the medics pushing mesh because it's cheap, quick, and produces a nice little earner from the drug companies?

[AngioJet]

Incidence of prolonged postoperative pain after open inguinal hernia repair is somewhere in the region of 30% and of these, 10% will experience pain severe enough to disturb everyday life (Franneby et al 2006, Franneby et al 2008). In the 2006 study, there was no difference in reported pain after mesh repair compared with non-mesh techniques although there have been other publications suggesting an increased risk of pain after mesh repair.

The reason mesh (and specifically, the Lichtenstein method which is the most commonly used method today) has become very popular is that compared with other techniques, the rates of recurrence are lower and the learning-curve of the operating surgeon is comparatively short. This is not a construct based on marketing by medical device companies that manufacture the meshes, but based on large epidemiological studies looking at hernia recurrence after surgery.

For bilateral hernias, the generally accepted approach is now to perform a laparoscopic (keyhole) repair (total extraperitoneal repair, TEP) with mesh insertion. There have been numerous studies assessing the outcomes after open versus laparoscopic procedures; one of the most recent was published last year where just under 200 patients were randomised to either Lichtenstein repair under local anaesthesia or TEP. 6 weeks post surgery, the TEP group reported significantly less pain interfering with daily activities (6/191 vs 16/187, P<0.05) (Dahlstrand et al 2013).

So in summary, there is no firm evidence that completely supports or dispels the notion that mesh repair increases the risk of groin pain after hernia repair. Laparoscopic repair is currently preferrable for patients presenting with bilateral or recurrent hernias after previous open surgery and may be associated with reduced postoperative pain compared with open repair.

If you're being assessed for hernia repair, make sure this is done at a high volume center, especially if you're being offered laparoscopic repair, as there's a steep learning curve for TEP.

Good luck!

[Radgirl]

I always worry about people claiming operations are simple or straightforward. They are until the complications occur. Angiojet correctly identifies that hernia surgery is not devoid of risk.

Mesh tension free repair is the gold standard. My advice is to go see a surgeon who does a lot. Sadly many 'general' surgeons think hernias are a bit infra dig, and leave them to the trainees. A few years ago there was a one day conference at the Royal College of Surgeons in London. The great and good stood up and presented 100, 200 or 300 cases. Then a chap who had set up his own hernia hospital and did nothing else stood up and presented thousands, with fantastic results, even though he wasn't a 'great and good'.

Your GP should know who is the best. GPs are very good at knowing where to send you!

[AngioJet]

If you're in the UK, there are regional differences in the funding of elective hernia surgery. Some clinical commissioning bodies do not fund uncomplicated hernias without any history of incarceration (which clearly is an indication for emergent surgery) and some will.
However, bilateral hernias are usually deemed 'worthy' of funding.

Moreover, in today's increasingly competitive environment even within the confines of the NHS, hernia repairs are increasingly performed by consultants, to meet production and quality targets. This is especially true for laparoscopic repair which is quite a specialised procedure which is not offered by everyone. So I wouldn't worry too much about being palmed off to a junior trainee!
That said, there are definitely registrars who by virtue of being more recent in their training and having larger current volumes are better hernia surgeons than their bosses, who may normally on a day-to-day basis do highly specialised e.g. colorectal or hepatobiliary surgery and only do a few hernias 'as and when'...