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Dr. Andrew Rynne

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How can inguinal hernia be treated?

Answered by
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 1942 Questions

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Posted on Fri, 20 Apr 2018 in Digestion and Bowels
Question: I have a inguinsl hernia now about 6 inched per catscan . One colonoscopy failed at interface from transverse to descending. I have been told more proficient dr with newest scopes should be able to do it...
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Capsule scopy should be done.

Detailed Answer:
Hello,
Thanks for choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.
I am sorry for your problem but a easy solution is capsule colonoscopy.A very small and highly sensitive camera would be swolled by you in form of capsule(size of a vitamin capsule).This camera is highly sensitive and would capture photographs while passing through you intestinal tract.As size of capsule is small it usually passes easily through intestinal tract.At some centres capsule endoscope is used for the same purpose.

Hope i was helpful.
Feel free to follow up my dear patient.
Warm regards.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Ramesh Kumar 51 minutes later
Had positive colo guard and Epi colon pro tests. Both positive so drs want to do another colonoscopy with newer scopes to see and remove any polio’s etc. they do not want to wait till I have a hernia repair before the colonoscopy all three past cold were meh except for internal hemeroids. That’s why I ask about newer scopes..incomplete colo was only done because it was tiebfor a batter esophagus check. Very small change in tissue. Consistently the same in the thought. Some drs say fix hernia first . My Dr is concerned because of positive cologuatd snd Epi blood test-marty
doctor
Answered by Dr. Ramesh Kumar 7 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
Hello again,
A positive result means the test detected altered DNA and/or blood that could be caused by cancer or precancer in the colon or rectum. Any positive result should be followed by a diagnostic colonoscopy.As in your case both cologaurd and Epi are positive i definitely agree with your gastroenterologist,You should not wait for hernia repair.

Options available for you are-
fecal immunochemical test (FIT), checks for hemoglobin in your stool most of the times almost more then 95% a precancerous or cancerous lesion show signs of bleed(not apparent by eyes) FIT is highly sensitive test and you should definitely go for it.

CT colonoscopy(virtual colonoscopy)-Non invasive CT scan would be used to visualize colon.

Combined together they are almost 90-95% sensitive to rule out cancer or precancer lesion.

Once hernia repair is done for 100% surety you could go for a check colonoscopy.
Please discuss this with your primary gastro and inform me what he/she says.

Hope i was helpful.
Warm regards and get well soon.

Thanks

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar 34 hours later
But if a problem is suspected they will want to try some type of colonoscopy. Hernia surgeon says the bowl in now descending into schrotum. How would I find a specialist that can property do a colonoscopy prior to hernia repair? What is the typical wait time from hernia repair and a colonoscopy???
doctor
Answered by Dr. Ramesh Kumar 10 hours later
Brief Answer:
follow up.

Detailed Answer:
Hello again my dear patient,
Hernia repair or any major surgery can be performed 24-72 hours post colonoscopy.
Colonoscopy is the same and a scope is used to do it.There are no different type of colonoscopes my dear patient.Its a standard procedure.
Any gastroenterrologist could perform this procedure however as your case is a bit complicated i would recommend you to find a colorectal surgeon.
Regards!
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 34 hours later
thank you, my plan is starting to be focused. The GI specialist says they have regular scopes and can use pediatric scopes or others if the standard scope is not appropriate. But they will not provide details on the scopes. They just say at their center which is rated in the top 5 in the USA they can do the job.
I have been referred by my Internist to the GI doc to get the colo asap because the epi procolon test cam back positive. I prefer to have the colo done by a colon-rectal surgeon, as you recommend, if it must be done before the hernia is repaired. Can you provide any information as to how long after a hernia surgery its possible to to the colonoscopy, and would a hernia surgeon or a good experienced general surgeon or a colo rectal surgeon be best for the hernia surgery. I saw one surgeon last week who said the bowl was starting to slip into the scrotum but another surgeon and same day did not say the hernia position would affect a colonoscopy. He only said the hernia surgeon would be happier if the hernia was repaired first? I plan in the next few weeks to get the camera procedure done and the VC with fecal tagging[ I may fly to UCSF]. But I dont know how to figure out which surgeon to believe and how to explain all this to my Interist...
doctor
Answered by Dr. Ramesh Kumar 22 hours later
Brief Answer:
follow up.

Detailed Answer:
I would suggest you to go for colorectal surgeon.
Colorectal surgeon is specialised to deal with colorectal complex conditions only however in case of unavailability you can go for a gastroenterologist.

Hernia surgery can be performed 72 hours post colonoscopy.
Please take a print out of my earlier explainations to your internist and see what she says.

I would suggest you(as per my experience) to go for a colonoscopy followed by surgical repair of hernai.
If colonoscopy fails again then post hernia repair colonoscopy can be performed again after 2 weeks.

Regards!
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ramesh Kumar 6 hours later
. Your help is most valuable. Interesting, the colo/rectal surgeon I am seeing is Dr Ravin XXXXXXX I am getting diferent recommendations for the surgery. I did have hernia surgery 20 years ago by a surgeon who was using mesh at that time. I do not know if the current tear is of the old hernia fix.-My question is basically about the Lichtenstein vs the ethicon [butterfly appering double mesh with one mesh inside and the other mesd outside ]]]approach. With either open or Laproscopic approach

when their is already [probably] a torn mesh hernia repair of 20 years ago.
doctor
Answered by Dr. Ramesh Kumar 18 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hi again,

As per me laproscopic is better as its minimally invasive with less complications post operatively.

Thanks!
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ramesh Kumar 26 minutes later
Problem is that surgeons say hernia is to big for laparoscopic approach!??!
doctor
Answered by Dr. Ramesh Kumar 15 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
I am sorry but in that case open lapratomy is advicable.Final decision depends on your treating surgeon.

Hope i was helpful.
Thanks and get well soon. in that case i am sorry you have to go for open approach.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 35 hours later
Dr, sorry for the delay . I believe you practice in Europe. I find Europe is more progressive than XXXXXXX How could I find more info about the recommended approaches to hernia repair when it’s a large hernia and a person had hernia repair 30 years ago with mesh by a progressive surgeon and also the Epi colon pro had been approved for Europe a lot longer than the USA and I wonder if there are statistics on the test. I realize that this would be a separate question but not sure who to ask . In USA, surgeons are almost complete booked till late January because of people using their insurance and then taking vacation . I am researching for a surgeon. XXXXXXX
doctor
Answered by Dr. Ramesh Kumar 12 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
Hello XXXXXXX
For EPI colon pro kindly go through the following articles.
https://www.ncbi.nlm.nih.gov/pubmed/0000
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/

However dear whether its denmark or asia or XXXXXXX if laproscopic procedure can't be done then you have to go for old school open abdomen surgery.
I don't think that there are any other options available.
Regards.
Above answer was peer-reviewed by : Dr. Kampana
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