Inguinal hernia

Is surgery necessary for inguinal hernias?

How should Hernias be treated?

Inguinal hernias are protrusions of the peritoneum, and the only effective treatment is surgical repair. Medication cannot restore the shape, much like how you can’t fix a car dent by changing the oil. More importantly, surgical treatment can prevent complications like the intestines getting stuck in the hernia, leading to incarceration or strangulation. Treating incarcerated or strangulated hernias might require more complex surgery, possibly involving the removal of parts of the intestine.

However, if surgery isn’t suitable for a patient, conservative observation might be considered. During conservative observation, attention should be paid to whether the hernia sac is gradually enlarging and whether there’s a risk of incarceration or strangulation.

Patient-Centered Approach

Before any treatment, understanding a patient’s basic condition and treatment goals is crucial. In fact, this should be the approach for all diseases and their management. Dr. Wu upholds a patient-centered principle, thoroughly discussing options with patients, aiming for the most appropriate solution.

During consultations, Dr. Wu aims to understand the patient’s:

  • Age: Consideration for conservative observation in older patients
  • Chronic diseases and cardiopulmonary function: Chronic cough? Chronic constipation? peri-anesthesia risks
  • Lifestyle: Extensive stair climbing? Agricultural work? Physical labor requirements?
  • Occupational nature: Sedentary or involving frequent heavy lifting
  • Work environment: Any conditions where hernia belts might not be feasible?
  • Original activity levels
  • Desired treatment outcomes

Real-life Cases

Here are some actual cases to better understand:

1. 88-year-old grandmother

She had a recurrent inguinal hernia, previously surgically repaired multiple times conventionally. Recently, the hernia recurred causing significant pain, affecting her life. Consulting a general surgeon, due to her old age, conservative observation with pain medication was recommended.

When she visited Dr. Wu, expressing a strong desire for surgery, Dr. Wu initially intended to recommend observation. However, given her surprisingly good cardiac function after thorough pre-operative assessments, Dr. Wu performed a Da Vinci robotic assisted surgery for her recurrent hernia. Post-operation, she was having lunch hours after surgery and experienced minimal pain, successfully discharged the next day.

2. 67-year-old man

He had bilateral inguinal hernias with noticeable symptoms that troubled him for years, and the hernia sac was progressively enlarging. Due to concerns about post-operative pain affecting work, he wished to avoid surgery. Dr. Wu performed a single incision laparoscopic hernia repair for him. After awakening from anesthesia without significant pain, he left the hospital on the same day to resume his work.

3. 73-year-old man

An avid hiker noticed significant pain due to an inguinal hernia recently. He was referred to Dr. Wu by other urologist for surgery. After a detailed consultation, Dr. Wu found that the patient’s pain level was moderate, and despite experiencing some discomfort, he could still engage in hiking activities. However, the patient was very anxious and concerned about the surgery. Therefore, although surgery is indeed recommended for this condition, Dr. Wu suggested using a hernia belt at appropriate times and then observing for a period. If the pain persists, surgery is advised. If the symptoms are not bothersome, continued observation is an option.

Conclusion:

Surgery is the standard treatment for inguinal hernias, but it’s recommended to discuss thoroughly with the physician before making a decision.

Next article, Dr. Wu will discuss “Surgical Treatment for Inguinal Hernias.”