I have what appears to be an indirect inguinal hernia. When I apply pressure to the bulging mass (about as big as a globe grape) it doesn't pouch-out after I bear down. My urologist told me that he could make a 4" incision and instead of suturing he would put some webbing into place(presumably to plug the opening in the inguinal foramen where the mesentary is protruding.  My question is has anyone ever heard of a less invasive way of correcting this problem? The bulge just appeared about 2 weeks ago. Has anyone had experience with this type of repair? Side affects? I'm a runner/golfer/surfer/Chiropractor and don't want to be 'out-of-action' for 4-6 weeks. Any reason this procedure can't be done arthroscopically? Would it be advisable to get an MRI first. I understand it could also be my bladder protruding from some anatomy reading. Thanks for your help. Should I avoid my activities? I feel it only mildly, at this point.  

4 inch incision? 1 - 1 1/2  inch incision is more typical for an inguinal
hernia repair unless you are obese.

The technique of using polypropylene mesh for a hernia repair is pretty
standard. The most common complication is transection or entrapment of the
ilioinguinal and/or iliohypogastric nerves. There is a possibility of a
wound and/or scrotal hematoma. During the dissection of the indirect hernia
sac from the {*filter*}atic cord, there is (remote) possibility that the
testicular artery could be damaged and you could lose the testicle. There is
also a (remote) possibility that the vas deferens could be damaged impairing
your fertility to a greater or lesser degree.

Typically, the patient's hernia would be repaired under local anesthesia
with some sedation. It would take about 20 minutes, he would go home the
same day. There would be about 36 hours of pretty significant pain when
doing such things as getting out of a chair or out of bed. Then the pain
will start to subside and the patient would be moving around pretty well by
the 7th day or so. Typically, there would be no activity or weight
restrictions other than "if it hurts, don't do it". Many patients are up
running/golfing/surfing/chiropracting within 7-14 days

An inguinal hernia can indeed be repaired laparoscopically, although the
benefits of doing so are debateable. It does typically adds general
anesthesia to the equation as well as longer OR time and a slightly
different set of potential complications. And it costs quite a bit more. The
recovery for activity is about the same, but there is less pain in those
first few days. You may have difficulty finding a surgeon that will be able
to do it laparoscopically, especially a urologist.

There is no urgency in getting a hernia fixed so generally patients have
plenty of time to get second opinions and/or find a surgeon that can do it
laparoscopically. The risk of not fixing it would be an
incarceration/strangulation of the hernia which could lead to an emergency
hernia repair in the unlikely event that happened.

HMc

Hernia surgery is usually elective.  Very small hernias need not be
repaired at all, as they are unlikely to strangulate, but since they
don't go away (except very rarely in newborns), the definitive cure is
always a (simple) surgical procedure.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Howard gave you a nice overview of the potential complications and
alternatives; so I won't repeat them or belabor them. However, I will
add my two cents regarding laparoscopic hernia repair. I concur
completely that it adds general anaesthesia to a procedure that doesn't
normally require general anaesthesia and that it takes longer and is
more expensive. My personal opinion on its relative merits is that it
has no advantage over a simple repair with mesh through an inguinal
incision using local anaesthesia and sedation and but does have several
drawbacks. However, for recurrent inguinal hernias, it has many
advantages over open repair, and I think its role ultimately will be in
complex recurrent inguinal hernias.

Finally, I also agree with Howard that there is usually no great urgency
(although your hernia is likely to enlarge slowly over months if you
don't get it taken care of, and over that time you do take a relatively
small risk of its incarcerating or strangulating). My suggestion would
be to see a general surgeon who does lots of inguinal hernia repairs for
a second opinion if you have doubts about your first opinion.

--
Orac        |"A statement of fact cannot be insolent."
            |
            |"If you cannot listen to the answers, why do you
            | inconvenience me with questions?"

HMc