Urgent Request for your advice on Inguinal Hernia Surgery and Recuperation

[leapfrog]

Thank you all. Should I understand that it would be better to have a laparoscopy? Why would the surgeon choose an open surgery? To avoid the risks of putting me to sleep or are there other factors involved? I really appreciate all of your input. Is this a common ailment in divers or does that have nothing to do with it?

 

[TSandM]

It's a common ailment, period.

I'm no longer up on technique in hernia surgery. When I quit operating, the laparascopic hernia repair was fairly new. It involved placing a square of mesh over the orifice of the canal from within the peritoneum. The advantage was no incision, but the disadvantage was that you didn't reinforce the repair with any native tissue; you were dependent entirely on the mesh to close the defect.

Each surgeon has to evaluate the patient, the type of hernia (indirect or direct), the quality of the inguinal floor and the quality of the native tissue, to decide which type of repair is most appropriate. Such things as anesthetic risk, time and cost may be considered as well. When I got out of it, there was a trend toward mesh-reinforced repairs having a lower recurrence rate, although no repair was perfect.

Inguinal hernias are common in general. Hernia repairs and gallbladder surgery were the two most commonly performed surgical procedures in adults when I trained. If you have a tendency toward a hernia, though, having to lift heavy gear on a repetitive basis is certainly going to contribute to developing one.

 

[cutlass]

So far, there's no definite evidence for the superiority of either approach.

For evidence-based medicine, the Cochrane Library is a widely respected source and here's one finding: link

In detail, the decision is complex as TS&M touches on, but very generally, I'd opt for a laparoscopic procedure for a recurrent or multiple hernia or if there is a compelling reason for a very quick return to full activity. Otherwise, I'd most likely suggest an open approach. Avoiding general anesthesia is a large factor. Being "put to sleep" is, technically and cost-wise, a big deal; e.g. more equipment, drugs, staff expertise, recovery -- just more variables to deal with. As related to complexity, I don't care for that fleeting second or two of initial adjustment to the relatively restricted field and reversed anatomical view (the scope is approaching from behind the hernia). As for cosmetics, final external scarring is a toss-up: an open might leave a single slanting, 6-7cm/2-1/2in scar whereas a lap procedure might leave three little 1cm/1/2in scars (vertically arranged for TEP, horizontally for TAPP).

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p.s. In cases of repeat hernia, the main reason I'd go for a lap procedure is that it usually provides an approach through clean tissue. Basically, the problem is internal scarring ("adhesions") which, in varying degrees, nearly always follows from abdominal surgery or injury. Think of it as being like gluing and sewing tissue layers and vessels and organs together. It can interfere with views; it can obliterate landmarks; it usually requires more and careful work to pick through; it can complicate healing; it sometimes can be just a pain in the arse....

 

[leapfrog]

Hi, all.

I had my operation this morning. The procedure used was a unilateral inguinal hernia repair using Marlex mesh.

1.Inguinal incision. 2. Disection of indirect inguinal hernia. 3.Repair with a plug and Marlex mesh. 4. Closed, vicryl 00 and staples.

Thank you all again for your advice and support.

This was done using local anesthestics.

 

[Thalassamania]

Take it easy for a while, keep us amused with your postings, most of all ... get well fast.

 

[leapfrog]

Take it easy for a while, keep us amused with your postings, most of all ... get well fast.

Thank you. I hope you know I appreciate you and respect you. If we didn't have differences of opinion, this would be boring. Thanks for this post, sir.

 

[Thalassamania]

The feeling's mutual. I'd hate a world where everybody agreed with me.

 

[ivakdiver]

OK, so I'm getting this surgery this November. Leapfrog, how long did it take before you could go diving?

 

[Duke Dive Medicine]

Cutlass has given far more detailed answers from a medical perspective than I can, but FWIW I had one fixed my junior year in college. It was an open procedure and no mesh was used, though the surgeon cautioned me against ever doing situps again lest I damage the area and need mesh placed. Being an ROTC midshipman at the time, I had to either (a) do situps or (b) lose my scholarship. I was cleared for full activity in less than six weeks, cautiously resumed exercise, and experienced no ill effects. I went to Navy dive school two years later. The repair has endured over 25 years of abuse and has held strong, which is a testament to the skill of the surgeon.

Caveat: Duke Dive Medicine does not condone doing anything against medical advice