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I am a middle-aged man. I had an operation 16 months ago for bilateral inguinal
hernia, with mesh inserted. Shortly before that operation, an ultrasound
investigation showed an umbilical hernia, but upon examining me, the surgeon
said he did not find such a hernia and thus would not operate on it. The
operation was open, as requested by my urologist, because he thought there was
the possibility that I may need to have my prostate removed in the
A few days ago, an ultrasound scan discovered three hernias,
including the old umbilical one and two inguinal hernias, which the radiologist
told me are internal, as opposed to the ones that were repaired. Another
senior surgeon I consulted about the recent ultrasound diagnosis did indeed find
the three hernias by clinical examination. He is not in a hurry to operate, and
he in fact asked me to lift objects, as well as my small grandchildren, and to
report back to him in a month as to whether the exertion was accompanied by
When I lift something and feel pain only eight hours later, is this
a direct result of the exertion? In my case, the former inguinal hernias were
not painful, while one of the “new” ones is mildly so, and the umbilical hernia
causes pain, but only rarely. The new surgeon has informed me that a second
hernia operation at the same spot is normally done the other way; that is, if
the original was an open operation, then the second one will be laparoscopic,
and vice versa. He also said that to do an open operation after a previous open
operation is very difficult. But I understand that a prostatectomy after a
laparoscopic hernia operation is also very difficult, if not impossible. So how
can I trade off the two difficult operations?
Could it be there is something
about my tissues that makes it likely that any hernia that I would correct would
only open again after a short time or is there something about the operating
technique that might cause this to happen? Finally, would I be best not
undergoing a hernia operation in the near future?
Ulano, a leading hernia surgeon and assistant director of the surgery department
at Netanya’s Laniado Medical Center and head of a private clinic in Bnei Brak,
Postoperative wounds can cause pain on exertion, regardless of whether
the repair was or was not successful. With time, the pains usual lessen
in intensity and frequency. I myself still feel some pains after heavy exertion
some 16 years after my hernia surgery. However, most people forget they ever had
Open prostatectomy surgery after laparoscopic hernia repair
may or may not be feasible depending on the local reaction to the mesh that is
inserted to strengthen the tissue. There are usually other ways to deal with
enlarged prostates not requiring the return to that operative site. The main
problem is if a radical prostatectomy is needed for a malignancy, which
fortunately is a much rarer occurrence.
Surgeons are aware of this
problem and try to minimize or avoid the dissection too close to the bladder,
trim the mesh in that area, or use lightweight meshes. The speed at which
patients want to return to work after laparoscopic hernia repair motivates the
use of this technique. You may have a genetic weakness of the tissues –
something that is more common after the age of 45 and even more so in smokers.
The use of mesh strengthens the repair and should prevent future hernias, so you
really should have no need to worry about recurrences.
technique can and does influence the recurrence rate. It should be noted that
many surgeons, including myself, rarely or never refer patients for an
ultrasound scan. This is because the radiologist may “see” something that may
have no significance whatsoever and should not be the basis for deciding on an
operation. That the second surgeon detected the new hernias is more significant.
Many of these findings need not require the patient to have a new operation. The
decision whether to operate needs to be made by the patient together with the
surgeon.Rx for Readers welcomes queries from readers about medical
problems. Experts will answer those we find most interesting. Write Rx
The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to
Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to firstname.lastname@example.org.