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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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How to treat an incisional hernia without surgery?

Answered by
Dr.
Dr. Hari Charan Perigela

General Surgeon

Practicing since :1995

Answered : 2534 Questions

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Posted on Mon, 29 Aug 2016 in Abdominal Pain
Question: I have an umbilical incisional hernia, and generally hear that I should reduce the body tissue protruding through the hernia to lessen the risk of incarceration or strangulation. Are there any risks of actually worsening one's hernia by manually reducing the body tissue protruding through the hernia? (Question for doctors other than Dr. XXXXXXX Rynne please.)
doctor
Answered by Dr. Hari Charan Perigela 1 hour later
Brief Answer:
You can reduce the content initially.

Detailed Answer:
Hi
Abdominal fat (Omentum ) or Small bowel will the content in a hernia sac of the Umbilicus. Initially, the contents will be reduced spontaneously or manually.
Once the content gets blocked,it is difficult to reduce. At this stage,you should not try to reduce.This is called stage of irreducibility.
If the content is Omentum, even though it is obstructed you will have pain only.But,if the intestine gets blocked, it will go into Obstruction, followed by loss of blood supply to that part leading to strangulation.
As there is no medical management for hernia, please get it operated as early as possible. I prefer Hernioplasty repair with Prolene mesh.
Hope I answered your query. If you have any questions, I will clarify further.
Wish you good health.
Regards
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Hari Charan Perigela 4 hours later
Thank you very kindly for your knowledge Dr. Perigela!

I have had my umbilical hernia since spring 2014. I can still easily manually reduce the protruding content such that there is no visible bulge, though the bulge eventually returns. It is sometimes a little sore or painful when I do this. First follow up question: Would you surmise from the above that the content is most likely omentum?

I have great hesitancy to do more than "watchful waiting" because this is an incisional hernia - a hernia caused by a surgically repaired hernia. I believe statistically that up to 20% of hernia operations have to be repeated within 5 years, and that this recurrence rate rises to 30% after a second operation, and to 50% after a third. I would of course be interested in repeated surgery if the hernia became incarcerated or strangulated. Second follow up question: Is there a way for me to tell if incarceration or strangulation occurs?

Wishing you and your family optimal health as well!

XXXX
doctor
Answered by Dr. Hari Charan Perigela 27 minutes later
Brief Answer:
It's better to undergo surgery now.

Detailed Answer:
Hi
1.Most of the times it is difficult to know the content .In few,bowel reduces by gurgling sounds. I have done many cases of Incisional Hernias without any further recurrence.
2.When there is obstruction, there will be abdominal distension, vomiting and constipation. If it is not relieved, then it leads to Strangulation where there will above symptoms, tachycardia, low BP etc.Patient may go into shock.
No one can predict the timing of complications.
I prefer to do surgery before complications.
I request you to undergo surgery as soon as possible as the General condition will be good and you will be fit for surgery now.
Hope I answered your query.
Regards
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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Follow up: Dr. Hari Charan Perigela 2 days later
Thank you for your thoughts and insights Dr. Perigela!

In mentioning that you've had no hernia recurrence in doing surgical repairs of incisional hernias, is this to say that you get sent patients with incisional hernias which are recurrent hernias from the work of other surgeons? I was under the impression incisional hernia refers to a hernia occurring at the repair site of a former hernia.
doctor
Answered by Dr. Hari Charan Perigela 5 hours later
Brief Answer:
I treat all types of Hernias.

Detailed Answer:
Hi
Incisional Hernia doesn't mean that it occurs from previous hernia repair. Any surgery over the abdomen can lead to Incisional Hernia. For example, after Hysterectomy or Caesarean section,due to poor general condition of the patient or cough after surgery etc,chances of Incisional Hernia are more.It can occur after any surgery in the abdomen. I have seen many cases after Appendicectomy surgery also.
Hernioplasty repair with Prolene mesh gives good results.
I work in a teaching hospital and it is a tertiary centre.Many cases,both complicated and uncomplicated cases will be referred to us from other Surgeons. We do many cases of Incisional Hernias without any further recurrence.
Hope I answered your query.
Regards
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Hari Charan Perigela 46 hours later
Thank you for all your insights and clarifications Dr. Perigela. Please let me know if you want me to say anything specific in writing a commendation for you once we close this conversation. I think my last question is this: I have mast cell activation disorder and can respond anaphylactically to many pharmaceuticals, including anesthesia. Are you aware of any anesthesias which could be employed in a surgical repair which methylate out of the body rapidly, and have a good track record for patients with chemical sensitivities and mast cell activation disorder?
doctor
Answered by Dr. Hari Charan Perigela 6 hours later
Brief Answer:
The anaphylaxis cannot be predicted.

Detailed Answer:
Hi
Anaesthesia drugs have to bring given cautiously in Mast cell activation disorder patients.
As per medical literature, the exact cause and timing of Anaphylaxis cannot be predicted.
I prefer Incisional Hernia surgeries under Spinal anaesthesia. We use Bupivacaine anaesthetic.Reaction to this drug is rare in mast cell activation disorder patients.
You should consult your surgeon, discuss your disorder with him as well as Anaesthetist and proceed accordingly.
Wish you good health.
Regards
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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