Think twice about hernia surgery

A reader asks, “Is it necessary to get a hernia repaired quickly?”

The time-honoured tradition has always been to fix it. But is this approach always the right one? Or is ‘tincture of time,’ namely watchful waiting, the best way to treat this common condition?

A hernia is a protrusion of bowel through a weak spot in the abdominal wall near the groin. But there is no sexual fairness in this condition. As one of my surgical professors used to say, “Sometimes you get the big brown egg.”

In this case the egg goes to men, as 90% of hernias occur in males.

In the past, surgeons believed that failing to return the bowel to its natural location inside the abdomen was fraught with danger. They worried that the bowel would become trapped in the hernia causing intestinal obstruction, a serious complication.

If this happens, the bowel may lose its supply of oxygenated blood resulting in gangrene and death if an emergency operation is not done. There was also the concern that small hernias could become larger making surgical repair more difficult.

Several years ago a study involving five U.S. medical centers, found that these surgical worries rarely happen.

To prove this point doctors followed 700 men with hernias that were causing minimal or no discomfort.

Half of the men were randomly selected to have the hernia repaired. The other 50% were told to monitor their symptoms and to report back for regular medical checkups.

To their surprise, surgeons discovered that the most feared complication, intestinal obstruction, occurred in less than 1% of patients per year. This is much better than the odds at Las Vegas. Moreover, any discomfort that was initially present did not increase over a two-year period in the majority of cases.

Twenty-five per cent of the watchful waiting group did eventually ask for surgery due to an increase in pain. But this delay in surgery had no effect on the complication rate such as infection, length of operation or the recurrence of hernia.

But what about the other half who initially were chosen to have the hernia repaired?

About 20% developed complications after the surgery such as infection, difficulty passing urine and three had life-threatening problems.

Other studies show that, even after a successful hernia repair, about 5% of patients continue to have pain. No surgical procedure offers a ‘free lunch.’

Since this study involved only men, it’s not known whether women or children who also develop hernias would have the same result. But one would suspect little or no difference.

Dr. Michael Alexander is an expert on hernia surgery at the Shouldice Hospital in Toronto. This facility specializes in hernia repair and is a world authority on this operation.

Dr. Alexander believes that surgeons must get rid of the idea that all hernias must be repaired. This applies particularly to the elderly if they are without discomfort. But age is not a factor as long as the patient is free of cardiovascular and other problems that increase the risk. He says his oldest patient was 99 years of age!

So we’ve all heard the phrase “If it’s not broken, don’t fix it.”

Now we can add another equally sound surgical dictum “If it’s only partially broken, there may be no need to fix it.”

In the past, the usual medical practice was to tell patients that gallstones had to be removed. It’s still true if there are repeated attacks of gallstone colic or if gallstones are small and are blocking the common bile duct that drains bile into the intestines.

But today, X-rays, CT scans and MRIs often detect gallstones even though these procedures are done for other conditions. In these instances, if the gallstones are not causing any problems, they are normally left for the crematorium.

So if a hernia is present, just remember that porcupines make love very, very cautiously. Be just as cautious about hernia surgery. Always ask yourself, “How much trouble is the hernia causing me?”

Your doctor should then make the final decision.

See the web site For comments

Just Posted

The Lending Cupboard lands new location on north end

New location - 7803 - 50th Ave. to be fully operational by August

Lacombe Generals punch their ticket to Allan Cup

6-1 win over Stony Plain finishes off series in 5 games

Local Legions will be presenting the award-winning play Jake’s Gift

Acclaimed play has received rave reviews from critics and audience members alike

WATCH: What’s Up Wednesday – March 21st

A summary of the week’s news

WATCH: What’s Up Wednesday – March 21st

A summary of the week’s news

Break and enter to Ponoka farm home while resident was inside

Caucasian suspects quickly entered the home and stole several items Tuesday afternoon

10-15 cm expected for parts of Central/Northern Alberta

Lacombe and south can expect around 2-7 cm of snow today and into tonight

Heavy ice off Canada coast strands pod of dolphins, fixating small town

The small Newfoundland community, Heart’s Delight, is fixated on plight of trapped dolphins

Foreign election interference a reality, says Trudeau after Putin re-election

Trudeau said the heavy use of social media and interference by foreign actors are the new reality in elections.

Canadians joining #DeleteFacebook amid fears of electoral meddling

Privacy experts say numerous Canadians are taking to other social media platforms to join in on the #DeleteFacebook hashtag

Schools close as spring snow storm tracks toward Maritime provinces

Schools are closing across the Maritime provinces as a spring snow storm tracks towards the region.

Son of late Canadian professor fights for mother’s release from Iran

Mehran Seyed-Emami’s father, an Iranian-Canadian professor, died in an Iranian jail after being accused of spying.

Deadly crash raises questions about Uber self-driving system

The fatality prompted Uber to suspend all road-testing of such autos in the Phoenix area, Pittsburgh, San Francisco and Toronto

Most Read