Umbilical Hernia to mesh or not to mesh?

December 17, 2016 7:21 AM

H has been diagnosed with an Umbilical Hernia, he is 62 yrs and very healthy. Hernia looks about 2 inches long, no pain, not bothering him. Info on the web is confusing. regarding types of surgery (open or Lap, robotic), and repairs (mesh, no mesh, special thread). We are in the NYC area: 1. Recommendations for Dr's 2. Opinions on choices in 2016 I know YANMD...Thanks
posted by drthom to Health & Fitness (8 answers total)

has life got more complicated? i had a hernia about, uff, 7 years ago, and they stuck a mesh in. i had some weird pain on very rare occasions the first month or so and then it's been fine. these kind of ops are really common - i suspect you could choose almost any standard option and it would work well.

the only thing that i didn't like was that i was given a general anaesthetic without warning - i think my anaesthetist was mis-cued by cultural / communication issues and decided i was more nervous than i actually was. but that's my own special snowflake circumstances, and a battle i've had to fight many times.
posted by andrewcooke at 7:52 AM on December 17, 2016

My son recently had a hernia repair. His doc told him when it was first found that unless it was causing pain or reduced his regular activities, he didn't recommend surgery. I think it was about two years later that it started causing pain. He had the mesh and he doesn't notice it at all anymore.

But yeah. I liked the doc saying that if it wasn't bothering him, he should just wait.
posted by cooker girl at 8:26 AM on December 17, 2016

Years ago I had hernia. Scheduled op. Then by chance picked up a doctor's book in which he told of people dying from selected but not needed surgery. Hernia was one and he said do not get unless painful and very obtrusive. I let it go for some time till it became painful and then had it done, with mesh, and no problem since. But back then mesh was new in U.S. and now it is fairly standard and much better than non-mesh stitching.
posted by Postroad at 9:45 AM on December 17, 2016

the flip side of waiting is that he's not getting younger. as we get older, we recover more slowly. also, i worry about antibiotics becoming ever more useless. so there are downsides to waiting.
posted by andrewcooke at 9:51 AM on December 17, 2016

Unless there's a reason to do an open procedure, the surgeon will almost surely opt for a laproscopy. It has significant benefits over an open procedure including increased comfort for the patient post-op. The robot is used by the surgeon to help improve their technique (improves visibility and range of motion) but that will really be up to the surgeon. Basically, I would say that whatever technique the patient and the surgeon decide on, just make sure that this is a technique that the surgeon is very comfortable with. Some surgeons have been doing laproscopic herniectomies forever and then need to learn to use the robot. You probably don't want your friend, loved one, self, to be the person that the surgeon is learning on. (That being said, I'm a nurse anesthesia student, and I am very grateful to all the individuals who have let me learn during their procedure).
posted by brevator at 10:51 AM on December 17, 2016

Actually, I misread your question and thought we were talking about an inguinal hernia. For an umbilical hernia the best treatment is really going to depend on the size of the hernia and how painful it is. Sorry bout that.
posted by brevator at 11:08 AM on December 17, 2016

I had an umbilical hernia repaired a few years ago, with mesh. I was totally nervous about it for a million reasons--I was scared of having general anesthesia, I was worried I'd be allergic to the mesh, I thought the recovery would be long and painful, I had read all kinds of terrible stories on the internets of things going wrong, etc. But my experience with it was completely easy and fine and I've had zero regrets and many moments of appreciation that I got it fixed. The mesh is well tested and durable and I can do situps and whatever weird abdominal moves I want without worry.

I switched HMO group within my medical plan because my existing group was a teaching hospital and, like brevator says, I just didn't want someone learning on me. I heard about the doctor I ended up using from a passing conversation with my ultrasound technician. The technician had had her own hernia repaired by him and I figured she probably sees the before and afters of many of these surgeries, so I trusted her opinion and experience. I'd say experience and bedside manner were probably the most important criteria in picking a doctor--this surgeon was someone who does several of these surgeries per day and it was really no big deal from his perspective but he was sensitive to my fears and able to reassure me completely.
posted by gubenuj at 11:51 AM on December 17, 2016

Best answer: I would expect if he wants surgery that he will be able to find someone to do surgery on him, but quite honestly the best and safest option if it is not bothering him at all is to leave it alone.

Regarding andrewcooke's concerns, 62 is not at all old from a surgeon's perspective, they routinely operate on octogenarians. And although I don't deny that antibiotic resistance is very concerning, there is no danger that antibiotics aren't going to work for most infections anytime soon.
posted by treehorn+bunny at 5:53 PM on December 21, 2016