Too many hernias leave reader frustrated

Dear Dr. Gott: I have had eight abdominal hernias and six operations in the past three years. The same doctor has performed these operations, using mesh each time, and each time another hernia comes on in a different location of my stomach. This is highly rare to have so many surgeries. My stomach looks like a tic-tac-toe board.

I’m 60 years old and carried mail for 34 years. I retired at the age of 55. I don’t know if my occupation has anything to do with my weak stomach lining or not.

Should I change doctors? Is there any other new procedure besides mesh? Does wearing a truss help any, and how many surgeries can be done on a stomach without causing further damage?

Dear Reader: Hernias occur when soft tissue protrudes through a tear or weakened area of the lower abdominal wall. This can occur because of strenuous activity, coughing that accompanies smoking or when muscles weaken later in life.

While some hernias go unnoticed, don’t cause any problems and aren’t discovered until physical examination, others cause great discomfort and are quite painful.

While anyone of any age – including infants and pregnant women – can develop hernias, they are more common in men. One reason might be that with the male fetus, the testicles form within the abdomen and proceed down the inguinal canal into the scrotum. After birth, the canal tightens, leaving adequate room for the spermatic cord to pass through, but inadequate room for the testicles to move back into the abdomen. A weakened area develops when the canal fails to close properly.

There are numerous reasons for a hernia to develop, including obesity, chronic coughing or sneezing, straining during defecation or urination and lifting heavy objects.

The most common, successful hernia repair performed today is hernioplasty, where a physician inserts synthetic mesh into the abdomen to cover the weakened spot. The mesh patch is secured with staples, clips or sutures. It is often done using a laparoscope so the surgeon can make several small incisions rather than one large one. This allows the patient to heal faster, with less discomfort, and to return to normal daily living sooner.

I cannot say whether your 34 years as a mail carrier is the cause for your multiple hernia sites. Perhaps you returned to normal function too quickly, strain too often or have other reasons for your many hernias. I must admit that I have never heard of anyone who has had eight hernias and six surgical-repair procedures.

In terms of wearing a truss, this is probably not in your best interests. Some surgeons recommend wearing one once a hernia is discovered until a surgical procedure can be coordinated, but they aren’t recommended for daily use.

I suggest you return to your surgeon and present your list of questions to him or her. If you don’t receive the appropriate answers, go back to your primary care physician and ask for referral to another surgeon. A second opinion is often the appropriate way to go.

To give you related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed, stamped, No. 10 envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.