Hernia operation at public countryside hospital

[ole1291]

Hello,

 

My 4 years old son (turning five in a month) son has a inguinal hernia.

We've already been at the Umphang public hospital, met a very nice young doctor who told us that though these operations were previously done at maesot (bigger) hospital they have recently started doing them in Umphang as well ( a team of doctors and anesthetist traveling from maesot a few days a months to cary them out).

 

She also gave us the option to go all the way to maesot to do it but assured us there's no difference from a safety point of view, she made a good impression on me.

 

I just want to ask if someone knowledgeable knows if that is correct? Or is there some equipment (which one) in the bigger hospitals that makes these kinds of operations safer there?

Edited July 8, 2023 by ole1291

[timendres]

I have an inguinal hernia that has required two operations. The second was actually quite dangerous, as a significant portion of my small intestines had to be removed due to necrosis caused by strangulation. My first operation was at 42, and the second at age 62.

 

The important point that my surgeon made was that each operation to repair the hernia weakens the entire area, lending to easier and more significant damage in subsequent episodes.

 

In other words, this is something that you want done right. Given that your son is only 4yo, and has many years of life ahead of him, I believe this is something that you want an experienced surgeon to be handling. They will likely do a better job at the surgery, but, more importantly in my mind, they will know what solution will likely provide the best and longest lasting result. Equipment and facilities may be equivalent, but there is really no substitute for experience.

 

My second operation was performed at Samitivej Hospital. Expensive, but I am quite happy with the result.

[ole1291]

Thank you for your input.

As we are doing this through the public  system, we have no say on who would perform the operation, but I'll keep this in mind.

 

My main concern however would have to do with any complications resulting from the anesthesia, as the doctor told us it's more delicate at this young age.

Is there any equipment (resuscitation?) might be missing in a local hospital vs a province capital one?

[connda]

Had my done in a public (government) hospital and it was just dandy.  Go for it.

[connda]

3 hours ago, ole1291 said:

Thank you for your input.

As we are doing this through the public  system, we have no say on who would perform the operation, but I'll keep this in mind.

 

My main concern however would have to do with any complications resulting from the anesthesia, as the doctor told us it's more delicate at this young age.

Is there any equipment (resuscitation?) might be missing in a local hospital vs a province capital one?

Yes - they do have proper resuscitation equipment.  But if you're so worried, go the a private hospital. 

[Sheryl]

To be completely safe in the (rare) event of complication you should have this done at a hospital with a pediatric ICU. 

 

The smaller hospital will not.  I'm not sure Mae Sot will either but you can ask. If not, the regional hospital in Nakon Sawang will.

 

 

[ole1291]

13 hours ago, Sheryl said:

To be completely safe in the (rare) event of complication you should have this done at a hospital with a pediatric ICU. 

 

The smaller hospital will not.  I'm not sure Mae Sot will either but you can ask. If not, the regional hospital in Nakon Sawang will.

 

 

I'm not sure that they would allow us to go to Nakhon Sawang, the choice given to us was either Umphang or maesot, and in my understanding, in the public system you don't get to choose so much... I will try nonetheless.

 

In any case, do you think this is an important thing to push for, or is the risk so negligible we can pass over it?

 

And assuming Maesot doesn't have a PICU, is there any reason to go there rather than Umphang?

[Sheryl]

12 hours ago, ole1291 said:

I'm not sure that they would allow us to go to Nakhon Sawang, the choice given to us was either Umphang or maesot, and in my understanding, in the public system you don't get to choose so much... I will try nonetheless.

 

In any case, do you think this is an important thing to push for, or is the risk so negligible we can pass over it?

 

And assuming Maesot doesn't have a PICU, is there any reason to go there rather than Umphang?

The risk is small but I would not call it negligible. 

 

General anesthesia (which will be required) is never to be taken lightly with a small child.

 

Maesot will surely have a larger/better ICU than Umphang if Umphang even has one at all. If they do not have a separate pediatric ICU then they will either combine   adults and children together or refer critically ill children to the regional hospital.

 

It is true that you cannot choose where you are sent through the public channel but you can sometimes influence it by asking the right questions/expressing concerns. Ask specifically about the availability of pediatric  ICU care in case of complications (and do not accept a "mai pen rai" sort of reply -- keep pushing).

 

I would not even consider doing this at a community hospital like Umphang.

 

As a general rule, anytime you are given a choice like this, choose the highest level facility. 

 

.  

[ole1291]

Thanks for your advice. Very valuable.

I'll definitely keep it all in mind next time we speak with them.

Umphang was enticing because of the proximity for all the follow up meetings etc... (once you choose a hospital for a particular problem, all the meetings take place there)

[ole1291]

Also forgot to mention, the operation will be sewing only, no net, which I thought were common now. 

Again, not something you get to choose.

[Sheryl]

45 minutes ago, ole1291 said:

Also forgot to mention, the operation will be sewing only, no net, which I thought were common now. 

Again, not something you get to choose.

Mesh is commonly used in adults, and sometimes in older children/teenagers. It is not used in young children.

[ole1291]

And with regards to his age, would it maybe be better to wait a few years?

The hernia only 'descends' some days and the operation seems to be elective.

[ole1291]

2 minutes ago, Sheryl said:

Mesh is commonly used in adults, and sometimes in older children/teenagers. It is not used in young children.

Duly noted. Thanks.