A 64-year-old man has a left inguinal hernia - USMLE Forums
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  #1  
Old 06-01-2012
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Surgery A 64-year-old man has a left inguinal hernia

A 64-year-old man is evaluated at a follow-up appointment. He had a left inguinal hernia diagnosed 6 months ago and has since had mild intermittent pain that is tolerable and does not interfere with his daily activities. He has not had previous hernia surgery, and he has had no episodes of bowel obstruction. The patient is reluctant to have surgery. He had a myocardial infarction 9 months ago, but has had no chest pain or other cardiopulmonary symptoms since then. Current medications are tamsulosin, aspirin, metoprolol, pravastatin, and lisinopril. On physical examination, the prostate is enlarged, and there is a left inguinal hernia that arises above the inguinal ligament and moves toward the scrotum with the Valsalva maneuver. Which of the following is the most appropriate management option for this patient?

A Defer surgery and monitor
B Laparoscopic hernia repair
C Open surgical hernia repair
D Prescribe a hernia truss
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Old 06-01-2012
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B
because pain in inguinal hernia means incarceration . :sorry::sorry:
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Old 06-02-2012
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Quote:
Originally Posted by Novobiocin View Post
A 64-year-old man is evaluated at a follow-up appointment. He had a left inguinal hernia diagnosed 6 months ago and has since had mild intermittent pain that is tolerable and does not interfere with his daily activities. He has not had previous hernia surgery, and he has had no episodes of bowel obstruction. The patient is reluctant to have surgery. He had a myocardial infarction 9 months ago, but has had no chest pain or other cardiopulmonary symptoms since then. Current medications are tamsulosin, aspirin, metoprolol, pravastatin, and lisinopril. On physical examination, the prostate is enlarged, and there is a left inguinal hernia that arises above the inguinal ligament and moves toward the scrotum with the Valsalva maneuver. Which of the following is the most appropriate management option for this patient?

A Defer surgery and monitor
B Laparoscopic hernia repair
C Open surgical hernia repair
D Prescribe a hernia truss
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  #4  
Old 06-02-2012
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Why not (A) Defer surgery and monitor ?
This patient has only mild symptoms and he is reluctant to surgery.
I think the best thing to do is to watch and wait.
Trusses actually won't give that good relief to his symptoms.
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Old 06-02-2012
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Watchful waiting with deferred surgery is an appropriate management option for this patient who is reluctant to have surgery and has minimal symptoms of an inguinal hernia. In selected patients with asymptomatic inguinal hernia, a wait-and-watch policy can be employed to avoid the risks of surgery (infection, chronic pain, recurrence) and anesthesia-related problems. The risk of developing obstruction is small in asymptomatic inguinal hernias, but it increases slowly over a period of time and requires symptom monitoring.
If symptoms worsen, the patient can then opt for surgery. A previous myocardial infarction or mild stable angina is not a contraindication to surgery, and inguinal hernia repair is a relatively low-risk surgical procedure. Two surgical techniques are commonly available: open mesh repair and laparoscopic repair. An open mesh repair is a quicker procedure and has lower rates of major complications compared with laparoscopic repair. Local anesthesia is the least expensive and most cost-effective option and is associated with fewer postoperative medical and urologic complications than general anesthesia or regional anesthesia. Laparoscopic surgery is usually preferable for bilateral hernias because it is less painful, less invasive, recovery is faster, and there is a lower incidence of numbness and pain. The increased cost of laparoscopic repair in patients with bilateral hernias is offset by earlier return to work.
No studies have shown that hernia trusses offer good control of symptoms. In fact, they may lead to spermatic cord atrophy or fusion to the hernial sac and atrophy of the fascial elements of the groin, which are important for the integrity of the groin after repair. Therefore, a hernia truss is not recommended for this patient.
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Old 05-14-2014
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1.Pt is reluctant to have Sx
2.Pt has enlarged prostate and constant straining might exacerbated inguinal hernia.
Give Pt hernia truss and appropriate Tx for Prostate hyperplasia (tamsulosin isn't enough)
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