Anyone here ever had a Hernia?

[slowbusa]

I'm the typical stubborn guy, been having pain in my groin, upper thigh for a while now. Well i have a fairly large mass right next to my groin, on my upper thigh on my right leg. Sharp shooting pain, burning sensation, stiffness, almost positive it's a hernia. I have an appointment this Friday to get it checked out. I'd just like to know if anyone has ever experienced one before? I guess they only way to fix this is surgery. I'd like to think im one of the toughest sob's you'll ever meet, (doesn't every guy ) but when it comes to anything surgery....i'm a pussy. I've heard so many horror stories of shit going wrong, my fear is they'll accidently do the wrong leg, saw it off, something! Bad...of course lol. Anyone know how long the surgery usually last's, how long i'll be down?

I know you guys aren't doctors, or looking for medical advice. Just looking for someone who's experienced one.

Thanks for any info.

yep but mine was on my left side i was told i was under for about 1hour or so but u will be on super lite dudies as u cant even sit up on ur owen for a few day have to take a laztive too no staining at all then lite dudy for about 6 weeks

[NightRider]

yep but mine was on my left side i was told i was under for about 1hour or so but u will be on super lite dudies as u cant even sit up on ur owen for a few day have to take a laztive too no staining at all then lite dudy for about 6 weeks

That can't be right. I'm definitely not taking a laxative....

[slowbusa]

to help u shyt with out staining i mite of said the wrong but i never took mine but they did give them to me

[NightRider]

to help u shyt with out staining i mite of said the wrong but i never took mine but they did give them to me

Haha, i know what you mean bro. But seriously...i dont think i'll take it.

[yotaman88210]

Its not a laxative, its a stool softener. Little bit of a difference, but Id take it I had the surgery. Why not? I mean how intelligent would it be to go through the surgery, then not follow the instructions for proper healing? Kinda a waste IMO

[NightRider]

Its not a laxative, its a stool softener. Little bit of a difference, but Id take it I had the surgery. Why not? I mean how intelligent would it be to go through the surgery, then not follow the instructions for proper healing? Kinda a waste IMO

If they give me something that's gonna make me shit myself, they can keep it. If they want to give me something that will help me go, then thats fine. I'm young, i'd rather not feel like an old person in a nursing home...you know? lol.

But yeah, i understand what you mean. Also, not to mention aren't most laxative's dispensed from doctor, etc, suppository?

[flounder]

If they give me something that's gonna make me shit myself, they can keep it. If they want to give me something that will help me go, then thats fine. I'm young, i'd rather not feel like an old person in a nursing home...you know? lol.

But yeah, i understand what you mean. Also, not to mention aren't most laxative's dispensed from doctor, etc, suppository?

Take what they give you and listen to them. If you shit yourself, then so be it but your hernia will heal..

As far as suppository comment goes, You evidently dont know much about medicine.

[NightRider]

Take what they give you and listen to them. If you shit yourself, then so be it but your hernia will heal..

As far as suppository comment goes, You evidently dont know much about medicine.

Never said i was a doctor. And a suppository is a laxative inserted into the rectum....is it not?

[PrincessPratt]

This is from uptodate.com. Unless you're in the medical field you won't have access to this website b/c it's about $600/yr for subscription. It's got great information. Hope some of this helps....I didn't read it all.

I have to post in sections but I'll try to get it all in.....

Treatment of groin hernias

Author

David C Brooks, MD

Section Editor

Mark D Aronson, MD

Deputy Editor

H Nancy Sokol, MD

Last literature review version 16.3: October 2008 | This topic last updated: March 31, 2008 (More)

INTRODUCTION — Hernias are areas of weakness or frank disruption of the fibromuscular tissues of the body wall through which intracavity structures pass. They are among the oldest recorded afflictions of man, and inguinal hernia repair is the most common general surgical procedure [1]. Surgery is the only effective treatment; however, the optimal therapeutic procedure is controversial.

Femoral hernias account for less that 10 percent of all groin hernias, but have a higher risk of incarceration or strangulation [2]. Hernias of shorter duration, both inguinal and femoral, also carry an increased risk of strangulation.

An overview of the treatment of groin hernias is presented here. The epidemiology, pathogenesis, clinical manifestations, and diagnosis of groin hernias, inguinal hernias in children, and abdominal wall hernias are discussed separately. (See "Classification and diagnosis of groin hernias" and see "Overview of inguinal hernia in children" and see "Abdominal wall hernias" and see "Abdominal hernias in continuous peritoneal dialysis").

SURGERY VERSUS WATCHFUL WAITING — The definitive treatment of all hernias, regardless of their origin or type, is surgical repair [1]. Outcomes are generally excellent with minimal short-term morbidity and rapid return to presurgical health. This is true even in elderly individuals, especially with the use of local anesthesia.

These surgical outcomes combined with limited outcome data in patients who do not undergo surgery have led to recommendations to offer surgery to most patients with a groin hernia, regardless of symptoms. The risks of delayed surgery are primarily related to the risk of incarceration and strangulation, which are the only true medical indications for repair of hernias. However, it is not possible to identify with any degree of reliability which hernias are likely to incarcerate or strangulate versus those that will remain uncomplicated.

The risk of incarceration is greatest soon after the hernia manifests itself. In one series of 439 inguinal hernias, the cumulative probability of strangulation was 2.8 percent at three months; the cumulative probability at two years was 4.5 percent [3]. The likelihood of incarceration also decreases as the hernia increases in size since it is less likely that intestinal or visceral contents will become caught within a large sac.

While surgery is clearly indicated for most patients with significant symptoms related to a hernia, it may be reasonable to delay surgery in patients with inguinal hernia who have minimal or no symptoms. The largest study evaluating the strategy of "watchful waiting," the WW trial, randomly assigned 720 men with an inguinal hernia to a strategy of watchful waiting or open tension-free hernia repair [4]. The men were at least 18 years of age (the majority were between the ages of 40 to 65), and were either asymptomatic or had only minimal symptoms (eg, absence of hernia-related pain or discomfort limiting usual activities, and no difficulty in reducing the hernia within six weeks of screening). The following results were noted:

At two years follow-up, there was no difference between the two groups in the primary end points of pain sufficient to limit activity or change in physical health scores.

Twenty-three percent of patients in the watchful waiting group had surgery within two years and 31 percent at four years. The rate of complications was not significantly different between patients who were assigned to and received surgical repair and those who were assigned to watchful waiting and then crossed over to receive surgical repair (21.7 versus 27.9 percent).

Significant hernia complications are rare but can occur in patients being watched. Overall, there were 0.0018 hernia-related adverse events per patient-year.

A smaller study (160 men), published subsequent to the WW trial, also found no difference in the rate of hernia accidents and pain scores between the surgery and watchful waiting groups, although patients who had immediate surgery responded that their general health had improved at one year, compared to a perception of health decline in the observation group [5].

The majority of patients in both studies were white men over the age of 40 with inguinal hernia. Thus, it is not clear whether these results are applicable to younger patients, women, other ethnic groups, or patients with non-inguinal hernias. Nevertheless, these findings suggest that a strategy of watchful waiting rather than referral for surgery can be considered in patients with asymptomatic or minimally symptomatic inguinal hernia, as long as they are aware of the risk, albeit small, of hernia complications and understand the need for prompt medical attention should symptoms of these complications occur. Although most authors agree that watchful waiting is a safe therapeutic option, some authors suggest elective surgery, rather than watchful waiting, for patients who are elderly, who have limited access to emergency care, or significant illness that would put them at greater risk for poor outcome after bowel strangulation [6].

INGUINAL HERNIA REPAIR — The most contentious aspect of inguinal hernia repair is the debate between proponents of the traditional open procedure and those who favor a laparoscopic approach [7] (see below). The major difference between the two techniques is that the open procedure is performed anterior to the defect, while the laparoscopic approach performs the repair posterior to the defect.

Regardless of the technique employed, successful surgical therapy is most often associated with a tension-free repair of the defect to decrease the recurrence rate. Past efforts to suture the defect closed resulted in unacceptably high recurrence rates, sometimes as high as 15 percent.

Modern techniques accomplished this goal by placing mesh over the defect, or in the case of the laparoscopic approach, behind the defect. The only currently available repair that does not utilize mesh and has an acceptably low recurrence rate is the Shouldice repair, which is discussed in the next section.

An important additional advantage of tension-free repairs is that they cause significantly less short-term pain and discomfort. This allows patients a more rapid return to activities of daily living.

Open repair — The Shouldice technique is commonly used for open repair of inguinal hernias [8]. This technique involves division of all layers of the floor of the canal followed by reconstruction in a four layer overlap technique utilizing continuous fine wire sutures [9]. This allows the defect to be closed with multiple layers, none of which are placed with inordinate tension. This completely obliterates the defect in the canal [9].

Shouldice and colleagues have reported recurrence rates of less than 2 percent using this technique in selected patients [10]. Their results have not been equaled by any non-prosthetic repair, and recurrence rates this low have not been achieved by other surgeons. The recurrence rate depends upon the level of surgical expertise; in one report of 183 inguinal hernias repaired under local anesthesia, the recurrence rates for beginners (less than six repairs under local anesthesia) versus more experienced surgeons were 9.4 and 2.5 percent, respectively [11].

Polypropylene mesh can also be used to cover the defect. It is the standard component of both primary and recurrent hernia repairs [12]. The two most common open prosthetic repairs are the Lichtenstein [13] and the "plug and patch" repair [14,15]. The Kugel repair places the mesh in a properitoneal position, rather than anterior to the transversus [16].

Polypropylene woven mesh (marketed under a variety of names such as Marlex, Prolene, SurgiPro) is preferred to other prosthetic materials for repair of inguinal and femoral hernias. Expanded polytetrafluoroethylene (ePTFE or Gore-Tex) is an alternative that has not gained wide acceptance for groin hernias but is used extensively for incisional hernias. This material does not provoke a significant reaction when placed directly over the serosal surfaces of bowel; this inflammatory reaction and the subsequent fibrosis that develops is believed to be necessary for a strong repair in the groin.

There are limited data comparing the recurrence rate of open mesh versus open non-mesh techniques [17]. An attempted meta-analysis concluded that mesh repair was associated with fewer recurrences, although the authors admitted that formal meta-analysis was limited by the lack of available study data [18]. A review of 26,304 herniorrhaphies performed in Denmark published after the meta-analysis found that mesh repairs had a lower reoperation rate than conventional open repairs [19].

[flounder]

Never said i was a doctor. And a suppository is a laxative inserted into the rectum....is it not?

A suppository is anything inserted for medicine delivery purposes.. not just a laxitive, and not just anally. Obviously there are orally taken medicines capable of the same thing.

For pain, I could give you a pill or inject you directly ... Do you get the point. Theres more then one way to do it. You dont have to be a doctor, you just have to have a little common sense.

[PrincessPratt]

Laparoscopic repair — There are three different laparoscopic repair procedures:

The totally extraperitoneal (TEP) repair is the most popular laparoscopic procedure [20,21]. This repair is performed in the preperitoneal, rather than the peritoneal, space. The surgeon develops a space between the peritoneum and the anterior abdominal wall so that the peritoneum is never violated. This may make visualization more difficult to the inexperienced surgeon, but in experienced hands this approach has the advantage of eliminating the risk of intraabdominal adhesion formation [21].

The transabdominal properitoneal patch (TAPP) repair involves the placement of mesh in a preperitoneal position, which is covered by peritoneum. This keeps the mesh away from the bowel. The advantages of the TAPP are that it does not leave intraperitoneal mesh and a larger piece of mesh is used. This leads to significantly lower recurrence rates than the IPOM [22].

With the intraabdominal properitoneal onlay mesh (IPOM) repair, a patch of mesh is laid across the defect in an intraabdominal position. The risk of adhesive complications from abdominal mesh is a concern of this technique [23]. This technique is rarely used currently.

A systematic review concluded that there are insufficient data from randomized trials to make firm conclusions about the relative effectiveness of the TEP and TAPP repairs [24].

Laparoscopic versus open repair — Proponents of laparoscopic hernia repair cite advantages such as reduced postoperative pain, and early return to normal activity. However, serious complications have also been reported, including nerve and major vascular injury, bowel obstruction, and bladder injury [25]. Additionally, performance of a laparoscopic repair may be technically challenging if the patient has had prior prostatic surgery. Similarly, performance of a TEP may make future prostatic surgery more difficult.

Systematic reviews of this topic have generally concluded that while laparoscopic repair is indeed associated with less postoperative pain and more rapid return to normal activities (including work), it takes longer to perform and may increase the risk of rare, but serious complications [26-28]. A cost-effectiveness analysis found that laparoscopic repair is associated with high incremental costs per quality-adjusted life years (QALYs) gained, although sensitivity analyses showed that there are specific situations in which laparoscopic repair may be a viable alternative, such as when reusable equipment is employed [29]. A study that investigated quality of life outcomes found that open repair was associated with at least as good, if not better outcomes, than laparoscopic repair.

A large, multicenter trial performed subsequent to the above systematic reviews included 1983 patients randomly assigned to an open mesh or laparoscopic mesh repair and came to similar conclusions [30]. Patients treated laparoscopically had less pain on the day of surgery and at two weeks, and returned to work one day earlier. Laparoscopic repair resulted in significantly more recurrences at two years (10.1 versus 4.9 percent) and was associated with more complications (39 versus 33.4 percent) including more life-threatening complications (1.1 versus 0.1 percent). Primary hernia repair by laparoscopy resulted in more recurrences than open repair (10.1 versus 4.0 percent) but had similar recurrence rates to open repair when performed for treatment of recurrent hernias (10.0 versus 14.1 percent). Surgeons who had performed more than 250 laparoscopic repairs had half the rate of recurrence of surgeons who had performed fewer repairs; no similar association with experience was seen for the simpler open repairs. Unlike some earlier trials that found lower recurrence rates with laparoscopic repair [31], all the open repairs in this trial were performed as tension-free repairs with mesh [32]. Patients were older (average age 58) and less healthy (only 34 percent were ASA class I) than the general population.

Laparoscopic repair may be advantageous in returning patients who perform heavy manual labor to work earlier [33], and open repair may be particularly advantageous in an older, less healthy population [30]. Open repair, as with laparoscopic repair, generally does not require overnight hospital stay.

FEMORAL HERNIA REPAIR — There are two different approaches to femoral hernia repair depending upon the size of the hernia. The simplest approach is anterior to the inguinal ligament and caudad towards the upper aspect of the leg. The hernia sac and contents can often be found at this location, dissected, and reduced if the sac is small. The defect can then be repaired with either a plug of mesh or direct suture. If the defect is particularly small, the contents of the sac (eg, fat) may have to be resected to reduce the hernia.

If a large volume of intraabdominal contents has protruded into the sac or if there is bowel in the defect, the best approach may be from the preperitoneal aspect of the inguinal canal. The transversus abdominis and transversalis fascia are divided and any intraabdominal contents are removed from the hernia. In addition, this approach allows the surgeon to inspect the bowel and insure its viability, which is important if a strangulated hernia is present.

ANESTHESIA — Hernia repair can be performed using general, regional (spinal or epidural), or local anesthesia [34]. Laparoscopic repairs using the IPOM or TAPP approach require general anesthesia and its attendant risks. TEP repairs are often done under general anesthesia, but can be performed under spinal or epidural anesthesia. General anesthesia may be used for the open approach, but it is generally not favored unless the patient has a compelling desire to be completely anesthetized.

Open repairs of inguinal or femoral hernias are most commonly performed using spinal anesthesia, continuous epidural anesthesia, or local anesthesia with or without sedation. Local anesthesia with sedation is referred to as monitored anesthesia care (MAC). It has the advantages of being completely controllable, not requiring prolonged postoperative observation, and being simple and easy to perform. The major disadvantage of local anesthesia is that it may be inadequate anesthesia for large hernias.

Local anesthesia can also be performed without sedation. This is suitable only for particularly motivated individuals who are not obese. The advantages of the sedative component of MAC anesthesia are that it can be individualized to the patient's specific desires for wakefulness and can be rapidly reversed at the end of the case. The patient must always be accompanied upon leaving the surgical suite if sedation is used.

Local anesthesia can be administered in two ways: as a nerve block of the ilioinguinal and iliohypogastric nerves or as direct infiltration into the proposed incision site. The former may be more difficult to achieve, but has the advantage of not causing significant soft tissue edema. Epinephrine can be added to the local anesthetic at the surgeon's discretion, but it is often omitted in patients with significant cardiac risks.

Spinal or continuous epidural anesthesia provides reliable anesthesia and allows the surgeon a greater amount of maneuverability since the anesthetized area is significantly larger than the operative field. Disadvantages include incomplete anesthesia, prolonged anesthesia, urinary retention, hypotension, spinal headache, and a longer time in the recovery area.

A randomized trial of local, regional, and general anesthesia in 616 adult patients in 10 hospitals undergoing open inguinal hernia repair found that local anesthesia was superior in the early postoperative period [17]. Patients who received local anesthesia had less postoperative pain and nausea, shorter time spent in the hospital (3.1 versus 6.2 hours with regional and general anesthesia), and fewer unplanned overnight admissions (3 versus 14 and 22 percent, respectively). Another multicenter randomized trial compared spinal and local anesthesia in 100 patients undergoing open hernia repair and also found local anesthesia was associated with less postoperative pain, shorter operating time, and fewer overnight stays [35].

RECUPERATION — As mentioned above, outcomes of inguinal hernia repair are generally excellent. The time period before the patient can return to work following open or laparoscopic hernia repair is typically brief, but depends upon many factors, including type of procedure, motivation, and employment status. As an example, one study found that the number of days off work was longer for patients receiving workers' compensation compared to those with commercial insurance (34 versus 13 days) [36]. Another randomized series reported patients not receiving worker's compensation had a shorter convalescence after laparoscopic than after open herniorrhaphy (8 and 11 days, respectively) [37].

Patients in sedentary employment generally may return to work within 10 days of surgery; those involved in manual labor should refrain from heavy lifting (>25 pounds) for approximately four to six weeks [37]. One small study that examined reaction times in an emergency stop simulation suggested that driving can resume 10 days following surgery [38].

STRANGULATED HERNIA REPAIR — Emergency surgery within four to six hours may prevent loss of bowel from a strangulated hernia. When bowel perforation has occurred due to necrosis from prolonged strangulation, the Shouldice operative technique is recommended. Mesh should not be used when there is gross contamination, but may be considered where contamination is minimal and broad-spectrum antibiotics administered during and for several days following surgery [1].

SURGICAL COMPLICATIONS — Ecchymosis and bruising are common accompaniments to groin hernia surgery. The type of hernia repair affects the complications that occur.

[PrincessPratt]

Early recurrence — The rate of recurrent groin hernias in the early to midpostoperative period can be minimized by avoiding infection, undue tension, and devascularizing tissues. In addition, specific recommendations such as weight loss in obese patients, cessation of smoking, and discontinuation of steroid therapy, if possible, will decrease the potential for hernia recurrence. (See "Recurrence after surgery" below).

Infection — Infections are uncommon postoperative complications. Skin flora are the most prominent etiologic organisms. A systematic review of seven randomized trials of antibiotic prophylaxis for open inguinal hernia repair found pooled risks of infection in the prophylaxis and placebo groups of 3.1 and 4.7 percent, respectively (odds ratio [OR] 0.61, 95% CI 0.32-1.17) [39]. Although this reduction in infection risk was not statistically significant, many surgeons routinely administer antibiotics prior to surgery. However, with the increasing problem of antibiotic resistance and low incidence of infection, this practice cannot be recommended. An additional argument for avoiding prophylactic antibiotics is that most inguinal hernia wound infections can be easily treated with a brief course (five to seven days) of an oral cephalosporin.

Patients undergoing mesh repair are at slightly higher risk of developing an infection. A meta-analysis of six randomized trials involving 2500 patients found that patients receiving prophylactic antibiotics had half the number of surgical site infections (1.38 versus 2.89 percent, OR 0.48, 95% CI 0.27-0.85) [40]. Most patients who develop a wound infection, even if polypropylene mesh is present, can be successfully treated by aggressive antibiotic treatment without the need to remove the prosthesis [41].

Seromas and hematomas — Seromas and hematomas are not infrequent complications after anterior hernia repair. They occur either because a dead space was left in place of a large hernia sac that was reduced or because of bleeding or fluid collection in the subcutaneous space upon or after closure. In the randomized trial of surgery versus watchful waiting cited above, 6.1 percent of patients undergoing surgery with an open mesh repair developed a wound hematoma, 4.5 percent developed a scrotal hematoma, and 1.6 percent developed a seroma [4].

Defined fluid collections infrequently require drainage or aspiration; most will either resolve on their own or, in the case of some hematomas, spontaneously decompress through the wound. This can be unsettling to the patient but is not a serious complication.

A pseudohernia can develop after a laparoscopic hernia repair. This occurs if a large hernia sac is not completely removed and subsequently fills with fluid or blood in the early post-operative period.

Pain and neuralgia — The prevalence of pain following hernia repair has been reported between 0 and 37 percent [42,43]. In a survey of 2500 Swedish patients two to three years after primary surgery for groin hernia, 30 percent reported some residual groin pain, and 11 to 14 percent reported that the pain interfered with activities (sitting, walking) [44]. Risk factors for postoperative pain were preoperative pain reported and occurrence of postoperative complications. Anterior repairs were associated with more pain than laparoscopic and open posterior operations, though interpretation of these findings is limited by the observational nature of the data (ie, patients were not randomly assigned to a specific procedure).

Pain following inguinal hernia repair is often due to neuralgia [42,45]. Neuralgia occurs due to injury or entrapment of any of the named sensory nerves that innervate the groin, including the ilioinguinal, iliohypogastric, genital branch of the genitofemoral, and the lateral femoral nerves [42]. The ilioinguinal and genitofemoral nerves are the most commonly injured during open surgery, while the lateral femoral nerve of the thigh is more commonly injured during laparoscopic repairs.

Neuralgias can be prevented by either meticulously avoiding manipulation of the nerves during dissection and creation of the repair or by intentionally sacrificing the nerve at the time of surgery. This latter maneuver leaves an area of relative sensory deprivation on the thigh or hemiscrotum, but it is a small sacrifice to prevent the significant dysfunction that can occur when one of these nerves becomes entrapped in scar or mesh. A randomized trial of patients undergoing Lichtenstein open hernia repair (n = 100) demonstrated lower incidence of chronic groin pain at six months (8 versus 28.6 percent) and no significant difference in sensory loss comparing patients who had prophylactic ilioinguinal neurectomy at the time of surgery with those whose ilioinguinal nerve was not excised [46].

Management of nerve injury or entrapment requires injection of local anesthetic into the groin for diagnosis and treatment of the neuralgia. In some cases, simply anesthetizing the nerve, even for a relatively short period, will break the pain cycle and eliminate discomfort. Alternatively, reexploration and neurolysis or resection may be necessary to eliminate the pain.

Stapling injuries to the nerves are the most common source of postoperative neuralgia in laparoscopic hernioplasty. These can be prevented by following well-established guidelines as to the location and position of the nerves and their relationship to the mesh patch used to cover the inguinal defect.

Unfortunately, some postoperative pain presentations may not be associated with specific nerves. When this occurs in the setting of mesh in the groin, it is appealing to consider removal of the mesh to eliminate the pain. However, this is unlikely to significantly reduce postoperative pain and may actually increase it by inadvertently damaging adjacent sensory nerves.

RECURRENCE AFTER SURGERY — Recurrences occur in 0.5 to 15 percent of patients. The frequency of recurrent hernias after surgery is a function of the type of hernia repair initially performed, the comorbidities of the patient, and the length of time from the original hernia repair. As mentioned above, open mesh procedures may be associated with a lower recurrence risk than non-open mesh procedures [18]. In the randomized trial of surgery versus watchful waiting cited above, less than 2 percent of patients had a recurrence at two years follow-up after an open mesh repair [4].

Hernia recurrences can be broken down into three functional time periods:

Immediate

Greater than six months and up to five years from the repair

Late recurrences beyond five years from the repair

Immediate breakdown is felt to be due to biomaterial breakdown or patient overactivity, intermediate recurrences appear related to technical (surgeon) factors, and late recurrence is due to the natural history of biology and aging.

The use of prosthetic material has dramatically diminished the earliest recurrences, but poor fixation, excessive dissection, and devascularization can lead to recurrences of the second type. Late recurrences continue to occur, but at a slightly decreased incidence.

Another type of "recurrence" occurs if the surgeon does not perform an adequate examination of all potential hernia sites at the time of the initial surgery. This can lead to an unidentified hernia later presenting as a so-called "recurrence."

USE OF A TRUSS — The only nonsurgical therapy for groin hernias is use of a truss, a device consisting of a strap similar to an athletic supporter with a metal or hard plastic plug that is positioned to lie over the defect. The hard disc or plug presses inwardly, reducing the contents of the hernia back into the abdomen.

There are insufficient data to determine the efficacy of trusses in controlling symptoms [2,47]. In addition, the truss is potentially detrimental; if the hernia contents protrude while the truss is in place, the truss may constrict the bowel or other hernia contents to such a degree that they are injured. Furthermore, prolonged use of a truss can lead to atrophy of the spermatic cord or fusion to the hernial sac and atrophy or deterioration of the fascial margins, making surgical repair more difficult [48]. Thus, use of a truss may be appropriate in rare situations but is generally discouraged.

[PrincessPratt]

SUMMARY AND RECOMMENDATIONS

The only effective treatment for hernias is surgery, and patients with significant symptoms related to their hernia should be referred for surgical repair. We suggest not using a truss in lieu of surgery, except for rare situations (Grade 2C). (See "Introduction" above and see "Use of a truss" above).

Watchful waiting rather than surgical referral is an appropriate option in patients with an asymptomatic or minimally symptomatic inguinal hernia, as long as they are aware of the small risks of hernia complications (incarceration and strangulation) and understand the need for prompt medical attention should symptoms of these complications occur. The risk of incarceration is highest soon after the hernia develops and in small hernias. (See "Surgery versus watchful waiting" above).

We suggest that most asymptomatic and minimally symptomatic patients with inguinal hernia undergo elective surgical repair (Grade 2A). Patients who wish to avoid surgery can reasonably be treated with watchful waiting.

Successful hernia repair depends upon a tension-free closure. It may be performed as an open or laparoscopic procedure and is typically achieved by placement of prosthetic mesh at the site of the defect. (See "Inguinal hernia repair" above and see "Femoral hernia repair" above).

Laparoscopic repair of inguinal hernias typically reduces recovery time but has a somewhat higher rate of rare complications than open repair. A decision regarding laparoscopic versus open approach will depend on local surgical expertise, and patient preferences regarding early discharge and shortened recovery time versus risk of hernia recurrence. (See "Laparoscopic versus open repair" above).

We suggest that patients undergo open repair, when the above factors do not clearly favor one surgical approach (Grade 2A).

Emergency surgery within four to six hours may prevent loss of bowel from a strangulated hernia. (See "Strangulated hernia repair" above).

Randomized trials have led to conflicting results regarding the role of antibiotic prophylaxis for routine hernia surgery. We suggest not administering parenteral antibiotics (Grade 2B). (See "Infection" above).

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[NightRider]

Wow. Thank you princess, much appreciated.

[flounder]

deleted-- sounded mean

[PrincessPratt]

That can't be right. I'm definitely not taking a laxative....

So apparently you don't want any opiods for pain control post operatively then? Opiods bind to receptors in your gut causing a decrease in peristalsis. Meaning you get constipated when you take pain medications. If you are NPO after surgery for some reason (there are many) you won't be able to take anything orally. They don't have stool softeners/laxatives in IV/SQ form. It will have to work from the bottom up. And FYI...constipation not dealt with can cause much pain, nausea/vomiting, and not to mention a perforation in your bowel. After you have your surgery do what the doctors say postoperatively.

[NightRider]

A suppository is anything inserted for medicine delivery purposes.. not just a laxitive, and not just anally. Obviously there are orally taken medicines capable of the same thing.

For pain, I could give you a pill or inject you directly ... Do you get the point. Theres more then one way to do it. You dont have to be a doctor, you just have to have a little common sense.

sup⋅pos⋅i⋅to⋅ry

   /səˈpɒzɪˌtɔri, -ˌtoʊri/ Show Spelled Pronunciation [suh-poz-i-tawr-ee, -tohr-ee] Show IPA –noun, plural -ries. a solid, conical mass of medicinal substance that melts upon insertion into the rectum or vagina.

I wasn't talking about the laxative for pain. Obviously, for pain...i'm more than likely to get a prescription for something. But, no where was pain mentioned. Just the fact i don't feel to comfortable taking a laxative. I mean taking some like, what Ducolax? That claims, "it doesn't make you go, it just makes going easier" Then yes, i could see using some like that.

I'm not sure where your trying to go with the common sense comment. So im just going to ignore it. I didn't join these boards to argue with people. So....no dice.

[flounder]

sup⋅pos⋅i⋅to⋅ry

   /səˈpɒzɪˌtɔri, -ˌtoʊri/ Show Spelled Pronunciation [suh-poz-i-tawr-ee, -tohr-ee] Show IPA –noun, plural -ries. a solid, conical mass of medicinal substance that melts upon insertion into the rectum or vagina.

I wasn't talking about the laxative for pain. Obviously, for pain...i'm more than likely to get a prescription for something. But, no where was pain mentioned. Just the fact i don't feel to comfortable taking a laxative. I mean taking some like, what Ducolax? That claims, "it doesn't make you go, it just makes going easier" Then yes, i could see using some like that.

I'm not sure where your trying to go with the common sense comment. So im just going to ignore it. I didn't join these boards to argue with people. So....no dice.

Re-read my statement. I specifically stated laxitive.. READ. READ. READ. The part about injecting you was a comparison to help you understand there are more ways then one to accomplish a goal. Obviously when I said "Get the point" you didnt get the point.

[PrincessPratt]

sup⋅pos⋅i⋅to⋅ry

   /səˈpɒzɪˌtɔri, -ˌtoʊri/ Show Spelled Pronunciation [suh-poz-i-tawr-ee, -tohr-ee] Show IPA –noun, plural -ries. a solid, conical mass of medicinal substance that melts upon insertion into the rectum or vagina.

I wasn't talking about the laxative for pain. Obviously, for pain...i'm more than likely to get a prescription for something. But, no where was pain mentioned. Just the fact i don't feel to comfortable taking a laxative. I mean taking some like, what Ducolax? That claims, "it doesn't make you go, it just makes going easier" Then yes, i could see using some like that.

I'm not sure where your trying to go with the common sense comment. So im just going to ignore it. I didn't join these boards to argue with people. So....no dice.

Well pain is a give me with surgery. You're going to have it regardless of what you do. And like I wrote earlier opiods and constipation go hand in hand. I work in palliative medicine and I prescribe bowel regimens every day b/c of all the pain drugs people are on. There is a difference b/t a stool softener (dulcolax) & a laxative (sennokot, etc.). A stool softener only pulls more fluid into your bowel to "soften" the stool. A laxative actually increases peristalsis which is forward movement of your gastric contents. What's wrong with pooping? It's what keeps us going every day. hey I just had a colonoscopy 2 weeks ago to check for colon cancer.....you really don't want me to tell u about my prep. That would really scare you.

and FYI...everyone knows that Aaron knows everything in life. Just accept it and move on!!!! hehe. sorry flounder just had to throw that in there!

[NightRider]

Well pain is a give me with surgery. You're going to have it regardless of what you do. And like I wrote earlier opiods and constipation go hand in hand. I work in palliative medicine and I prescribe bowel regimens every day b/c of all the pain drugs people are on. There is a difference b/t a stool softener (dulcolax) & a laxative (sennokot, etc.). A stool softener only pulls more fluid into your bowel to "soften" the stool. A laxative actually increases peristalsis which is forward movement of your gastric contents. What's wrong with pooping? It's what keeps us going every day. hey I just had a colonoscopy 2 weeks ago to check for colon cancer.....you really don't want me to tell u about my prep. That would really scare you.

and FYI...everyone knows that Aaron knows everything in life. Just accept it and move on!!!! hehe. sorry flounder just had to throw that in there!

I see what the both of you are saying. Flounder/Aaron....at 1st, i didn't get what you meant, but i do now. Some people are a little slow on the uptake. That would be me lol. It's all good and i appreciate the info from the both of you. Most likely, i'll do what the doctor's tell me to do. I honestly don't think spurning a doctor's order's/wishe's would be the way to go. I was just trying to emphasize the fact that, i didn't/don't want to feel like someone who can't control their bowels.

[flounder]

I see what the both of you are saying. Flounder/Aaron....at 1st, i didn't get what you meant, but i do now. Some people are a little slow on the uptake. That would be me lol. It's all good and i appreciate the info from the both of you. Most likely, i'll do what the doctor's tell me to do. I honestly don't think spurning a doctor's order's/wishe's would be the way to go. I was just trying to emphasize the fact that, i didn't/don't want to feel like someone who can't control their bowels.

as an fyi.. I wasnt trying to be a dick. 1. its just my nature, 2. Im crabby at work today.

[NightRider]

as an fyi.. I wasnt trying to be a dick. 1. its just my nature, 2. Im crabby at work today.

It's cool. It probably doesn't help that your stuck at work, when you could be riding, huh?

[jbot]

you don't need no surgery!

if people ask about the weird mass next to your junk, just tell them you were too manly for 2 balls, so your body grew another one in order to survive.

there, i just saved you a couple thousand dollars, a few days off of work, and instantly upped your chuck norris rating. ok, so you'll have pain and possible health complications for the rest of your life... but at least that life will be filled with manliness as well as soul crushing groin pain.

[NightRider]

you don't need no surgery!

if people ask about the weird mass next to your junk, just tell them you were too manly for 2 balls, so your body grew another one in order to survive.

there, i just saved you a couple thousand dollars, a few days off of work, and instantly upped your chuck norris rating. ok, so you'll have pain and possible health complications for the rest of your life... but at least that life will be filled with manliness as well as soul crushing groin pain.

[SAMBUSA]

If they give you a softener, take it. Do yourself a favor. TRUST ME!! I know from experience. After going under for surgery and the meds that follow, you are gonna be plugged up really bad. I'm not talking about avoiding strain for your junk, just your brown eye. Bad memories.........