Q: I am a 70-year-old female who had abdominal surgery three years ago for an obstruction. The abdomen didn’t heal properly and I now have a larger hernia. I went back to the surgeon who said the condition would be preferable to surgery, as netting would have to be used in the repair and if an infection occurred, it would be a real problem. He gave me an abdominal belt to wear but I am having a lot of discomfort and pain when I even lift something light. I am wondering if it would be better to have the surgery than to feel like this all the time.
A: A hernia is a protrusion of intestine or other tissue through the area where it is normally contained. A hernia can be classified as either internal or external and as abdominal or thoracic. Those of the abdomen can occur spontaneously or following surgery and presumably from congenital defects, as well. When following a surgical procedure, they are referred to as incisional hernias that can be of any size from small to rather large. Some may be so large the contents are considered unable to be reduced because the abdominal wall may be chronically injured. An incisional hernia is very common. In fact, of the approximate four million laparotomies performed in our country annually, up to 15% of that amount will result in incisional hernias. Fifteen percent!!! All the blame cannot be directed toward the surgeon, as the cause for this is a primarily failure of the fascia to heal. .Almost half of all incisional hernias will be present within the first two years following the surgical procedure, and 74% will occur within three years.
Depending on the size, repair varies from suturing to major reconstruction of the abdominal wall with muscle flaps and surgical synthetic mesh. Laparoscopic repair involves placing mesh in the abdomen without reconstruction of the abdominal wall. The mesh is fixed with tacks, staples or sutures. Repeat incisional hernia repair is considered to be a challenge, since the chances of failure increase with each additional attempt. Further, some individuals with other medical issues may be at a higher risk for complications. Along these lines, I don’t know what other medical conditions you might have that would precipitate your physician indicating he feels you would be better off health wise if you don’t undergo repair. However, it can’t be a walk in the park to wear a belt for the rest of your life to keep things in place.
I recommend you seek a second opinion from another surgeon. Take your paperwork with you for his or her review and without pointing any fingers, state the facts, your medical history and other relevant information. Then obtain the views of the second surgeon. If it is similar to the first one received, you will have your answer. If not, you may have your way and will undergo repair. If the latter is the case, be sure to adhere to all restrictions regarding weight lifting and other limitations that hopefully will prevent a recurrence.
