Watch-and-wait policy for hernia has reader concerned
DEAR DR. ROACH: I am an 84-year-old female with a protruding stomach bulge. My surgeon confirmed that it’s a hernia, which I got while taking care of my handicapped husband (who recently passed away). Since I had two abdominal surgeries two years ago, he does not want to do surgery again. The hernia is located on the right side, next to the surgery scar, about 2 inches above my bellybutton. It is hard to describe the size, maybe like a small egg. I weigh 110 pounds and am 5 feet tall.
Is it dangerous to do nothing? Could there be a strangulation in the future? I am binding myself with a bandage when doing exercise or housework. Will that cause problems? -- G.M.W.
ANSWER: A hernia is a defect in the abdominal wall. They most commonly occur in or around the inguinal canal (where the large blood vessels exit the abdomen), located near the umbilicus (bellybutton), or at sites of previous surgery. If the defect is large enough, the abdominal contents can push through the defect, resulting in a visible and palpable mass over the defect. If the defect is just the right size, the bowel that has been pushed through the defect may get stuck there, which is called an “incarcerated” or “strangulated” hernia. This is life-threatening, and anyone living with a hernia should be warned that a mass over the hernia that cannot be pushed back in should be evaluated right away.
Surgeons are the experts in managing hernias, and I trust their judgment in balancing the risks of leaving the hernia alone and the risks of performing surgery. The size of the hernia you describe may be too big for there to be a large risk of strangulation, although only a careful physical examination (or imaging study, such as ultrasound or CT scan) can inform that judgment.
Surgeons often prescribe a truss or binder for people with hernias that are judged not to require surgery. Ask the surgeon if that is right for you.
DEAR DR. ROACH: My doctor told me I have a heart murmur. At the same time, I heard about a new treatment for aortic valve replacement. Is this a cure for my murmur? I am 87, with a touch of multiple myeloma. How serious is this operation? I hear the new procedure is less invasive than open heart surgery. -- R.T.
ANSWER: A murmur is a noise made by blood flowing through the heart. In some people -particularly young, active people -- even with normal valves, a murmur can be heard. However, a murmur often indicates an abnormality of one of the four valves of the heart. The quality and loudness of the murmur helps indicate how concerning it is. If your doctor was worried about it, he or she probably would have obtained an echocardiogram to determine which valve is affected, and to what degree. People with very severe stenosis (narrowing) of the aortic valve may need treatment; the valve prevents the backward flow of blood that is leaving the left side of the heart and going to the body. Symptoms of severe aortic valve disease include fainting, chest pain or fatigue and swelling.
I think you mean a “valve-within-valve procedure,” also called a “transcatheter aortic valve replacement.” It is an excellent option for people with very severe aortic stenosis who have higher-than-average risk factors for open heart surgery, including older age and other medical conditions. However, there is no reason for you to consider this surgery unless you have a diagnosis of severe valve disease, usually seen with symptoms.