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When You Shouldn’t (Or Could) Wait to Have Hernia Surgery

Man pondering wether a doctors visit is necessary for his hernia symptoms

To give you the most comprehensive answers to common questions and topics, this article will explore the nuances of hernia surgery – specifically about when patients can reasonably wait to have hernia surgery or when they should have it as soon as possible. Of course, every situation is unique, and a consultation with a qualified hernia surgeon such as Dr. Tsuda is the first and best course of action.

There are many types of hernia – inguinal, femoral, incisional, umbilical, hiatal, and more – each with unique complexities. The commonality between them is that many of these hernias can start as minor, causing minimal pain and discomfort. The fact that hernias can seem so benign offers a false sense of security. Patients think that since there is little or no pain, the hernia is not a big deal and doesn’t need repair. But by their nature, hernias tend to get worse, and this worsening can be rapid, depending on certain circumstances. As such, surgical repair for a hernia is usually the best course of action for a healthy, suitable patient. Let’s explore the potential complications of an untreated hernia:

  • The most acute complication of hernia is incarceration or strangulation of the herniated abdominal contents. This emergency requires a visit to the ER and immediate surgery to reduce the hernia contents (put them back in place). Incarceration occurs when the abdominal contents cannot slide or easily be pushed back through the defect. Strangulation occurs when the incarcerated contents lose blood flow, and tissue begins to die. If left untreated, this condition can be very serious, even fatal. Luckily, strangulation is a rare complication of a hernia – however, patients with a femoral (upper thigh) hernia have a significantly higher likelihood of strangulation versus other hernias.
  • Related to the above, strangulated hernias are emergent situations requiring immediate surgery. Statistics show that emergency hernia surgery has the potential for more significant complications than surgery performed electively. As such, we suggest that patients have surgery in a controlled environment by the surgeon of their choice when possible.
  • When most patients come to us suspecting a hernia, they have either noticed a bulge in their abdomen or have pain or discomfort – which can be mild or significant. Unfortunately, these persist until the hernia is corrected by surgical means. Losing some weight to reduce the pressure on the abdomen can help but typically does not do much for a symptomatic hernia.
  • Last but not least, hernias are a progressive condition. We know they cannot be repaired without surgery and will worsen over time. As the pressure from the abdominal contents pushes on the defect, it expands. This can happen over weeks, months, or even years. However, a large hernia defect is more challenging to repair, requires more mesh to cover, and can lead to more complications.

Who Is a Good Candidate for Surgery?

  • Younger, healthy patients are typically recommended for surgery because of low surgical risks. Further, younger patients tend to have more robust abdominal muscle structure, which can increase the chance of incarceration or strangulation.
  • Patients with smaller hernias may also benefit from surgical intervention sooner rather than later, as these are more likely to strangulate than larger hernias.
  • Patients with femoral hernias, more often found in women than men should have surgery urgently, as this type of hernia tends to strangulate more frequently.
  • Lastly, those experiencing significant pain or discomfort from the hernia may wish to have it repaired for lifestyle reasons. We’ve also noticed that the more pain patient has before surgery, the more likely they are to experience continued pain after surgery.

Who Is a Good Candidate for Watchful Waiting?

  • Older patients typically have weaker abdominal muscle structure allowing the herniated contents of the abdomen to retract quickly. This reduces the risk of strangulation or incarceration.
  • Patients with larger hernias may also opt to wait to have them repaired, as this size hernia defect tends to have a lower incidence of strangulation or incarceration.
  • Those with a high degree of surgical risk, usually due to poor general health, may not be candidates for elective hernia surgery until their health improves.
  • Lastly, patients who do not have significant symptoms that impede their lifestyle – typically those who found their hernia incidentally – may opt not to have a hernia repaired if the likelihood of strangulation or incarceration is low.

With the exceptional safety and effectiveness of modern hernia surgery and mesh technology, it is usually best to correct a hernia sooner than later unless there is a significant reason to the contrary. Addressing a hernia can avoid further problems, both in the short and long term. To learn more about the best surgical option for your hernia problem, you can contact our office to schedule a consultation.

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