Hernia

[willsabl]

I am a 55 year old man.A year and a half ago I got a hernia.The hernia is according to my doctor fully presented and reduces at night and comes out in the morning when I get out of bed.It is large,the size of a fist in my scrotum.There is no pain except for some discomfort when it first comes out in the morning.I continue a full exercise regiment with no pain.I had an ultra sound to confirm my doctor's diagnosis.There is no strangulation or other danger according to my doctor.It is asthetically very uncomfortable but otherwise not a hardship.My GP is opposed to surgery but will send me to a surgeon if I insist.I am in a Medicaid HMO and am not sure whether I am getting the accepted medical advice in my case or am being steered away from surgery for HMO financial reasons.If I do nothing and just live with it as my doctor wants am I headed into possibly dangerous waters.Thank you.

[Kevin Pho, MD]

I would agree with the comments below.  It would not hurt to obtain a surgical opinion.  If the hernia is reducible, and as large as you describe, the changes of strangulation are lower.  If the symptoms start to cause marked discomfort, then that is a stronger indication for surgery.  If not, then it is likely that it can be watched.

Financial reasons should never be a reason why a surgery referral is denied.  If you want another opinion by a surgeon, you should insist.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[surgeon]

Just for the record, ultrasound was an unnecessary test for a hernia that behaves the way you describe: nothing but a hernia will do that. In general, the reasons to repair a hernia are to relieve discomfort, or to prevent or treat complications. The most dangerous complication of a hernia is "strangulation," wherein the intestine which is going in and out gets stuck and squeezed so tightly that the blood to it is cut off, and it starts to die. That's much more likely with a smaller hernia, which goes in and out with difficulty. One the size of yours is unlikely to strangulate. So the main reason to repair it is to relieve discomfort, which you don't seem to have. The other consideration is that in the vast majority of instances, hernias tend to get bigger with time. So what is somewhat annoying now is likely to get moreso as time passes; and fixing a huge hernia is a bit more difficult, and has a higher recurrance rate than with smaller ones. The perfect decision requires a crystal ball: what exactly will happen to you and only you, if you do or don't get it fixed. No one can  say for sure. Odds are it'll get bigger and bother you more. You didn't say why your doctor is against it: if you have medical conditions that make the surgery unusually risky, that needs to be taken into account. It can't hurt to be seen by a surgeon for his/her opinion.