Inguinal hernia repair

[OccamsRazor]

I have a double Inguinal hernia, right side much larger than left, bulge about size of an egg until I lay down and it goes away.  I made an appointment at Chiang Mai RAM to see a recommended GI doctor but was disappointed in their handling of me.  I handed a print out of the timeline of my symptoms to the receptionist.  She took me up to a waiting room and a few minutes later came back and handed me off to a general surgeon.  Did not even see or talk to the GI as I was 95% sure what it was but wanted verification from him and my options.  Appears my details were too good.  ????

My main question is which repair technique to use.  Mesh repair is the most common but after reading several studies and patient comments I'm hesitant to go that route.  Some patients having pain after over a year and other complications.   Subsequent repair is complicated as nerves, veins, tissue grow into the plastic (a foreign object.)

 

So I'm looking at natural tissue repair such as the Shouldice technique.  Is this offered in Thailand, specifically Chiang Mai?  And recommended surgeons for either technique.

[Sheryl]

Beware of anecdotal patient reports and "studies" which do not meet scientific criteria. In some cases shoddy malpractice lawyers lie behind this sort of thing.

 

The most up to date data confirm that mesh repair is superior both in terms of short term complications and avoiding recurrence. See

 

https://www.cochrane.org/CD011517/COLOCA_comparing-surgical-groin-hernia-repair-performed-or-without-mesh

 

and also

 

https://www.ucihealth.org/blog/2018/06/mesh-hernia-repair

 

I do not know of any surgeons here doing non-mesh inguinal hernia repairs.

 

GI doctors do not treat hernias. Yours actually did you a favor diverting you and thus saving you a needless consultation fee,

 

 

 

 

[nzrick]

If I were you, I would not even consider surgery unless you have symptoms more than the awareness of an egg sized bulge.

No mesh is available yet that is ideal, and recurrence post-op cannot be guaranteed. Statistically, Shouldice only has the lowest recurrence rate when carried out by the Shouldice Clinic. (and that fact could be challenged see here:  canadianfemalesurgeon.wordpress.com/2015/05/19/the-problem-with-shouldice-or-the-most-dangerous-phrase-in-the-english-language-weve-always-done-it-this-way/)

 

How old are you? What's your BMI, your gender, overall health and level of fitness? 

Currently, life-altering CGP (Chronic Groin Pain) post-op is running at 12 to 17%.

 

In short, if you are asymptomatic, better to live with it than take the risk, that's what I'm doing!!

[Sheryl]

The reason for repairing an inguinal hernia is to avoid the risk of strangulation which is a life threatening complication. For most people the risks of the surgery are significantly less than the risks of not having surgery. Exceptions would be people with unusual risk factors for surgery..advanced age, chronic diseases, extreme obesity etc.

The younger & fitter you are, the stronger the argument for surgical repair.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[OccamsRazor]

42 minutes ago, Sheryl said:

The reason for repairing an inguinal hernia is to avoid the risk of strangulation which is a life threatening complication. For most people the risks of the surgery are significantly less than the risks of not having surgery. Exceptions would be people with unusual risk factors for surgery..advanced age, chronic diseases, extreme obesity etc.

The younger & fitter you are, the stronger the argument for surgical repair.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

72 years old, 69kg @178cm (normal weight for age/height).  Moderate high blood pressure managed with Concor, last check was 130/75.  No chronic diseases, no allergies.  I did have a hernia repair ( epigastric hernia?)  at around 35 years of age in the mid abdomen possibly from being very physically active at the gym and sports.  I'm pretty sure that was a simple suture repair.

 

As for asymptomatic, I would say quite a bit.  Mild to moderate pain probably 30% of the day excluding sleeping, and burning sensation probably due to the bulge stretching the skin, baby powder helps.  Irregular bowl movement which I've tried to improve with soluble fiber and lots of fruit juice daily (apple, orange, lemon, even some prune) with little help.  Difficulty urinating including starting and flow rate.   Pain is predominantly while sitting at the computer for long periods. 

As for 'anecdotal' reports, I stick with peer reviewed articles and well established medical sites such as Mayo, etc.

That 12-17% number for chronic pain after is what makes me quite hesitant with mesh.  Thanks for the links and advise, will go over them.