Nearly 1 million hernia surgeries are performed in the United States each year. To better understand the causes and management of hernias, we spoke to Dr Shirin Towfigh, one of the few surgeons in the United States whose practice is 100% dedicated to the treatment of hernias.
Dr. Shirin Towfigh
Dr. Towfigh received her Bachelor’s degree from UCLA and her Medical Doctorate degree from UC San Diego. She completed her surgical training and research at UCLA. She is Board Certified in General Surgery by the American Board of Surgery. She is an award-winning educator, with experience training and mentoring thousands of medical students, residents, and fellows at the USC Keck School of Medicine, LA County + USC Hospital, the Norris Cancer Center, David Geffen School of Medicine at UCLA, and Cedars-Sinai Medical Center
8/25/2021
Better Man Clinics
Everyone has heard of a hernia but I’m not sure if everyone knows what a hernia actually is. What is a hernia?
Dr Towfigh
A hernia is technically a hole. Usually, the hole is within some muscle or fascial lining. It is a muscular problem. Sometimes that occurs around the belly area. Sometimes it is in the chest. Typically we talk about abdominal hernias or abdominal wall hernias. Many of you have seen bulging in the groin or an “outie” belly button. Those are all considered hernias. And some hernias are a result or side effect of surgery.
Better Man Clinics
So there are different types of hernias. Today, I think we’ll focus on inguinal hernias, or groin hernias, because those are the ones that the average guy comes across when they get a little too excited in the gym and, all of a sudden, you have an unwelcome friend that arrives. What type of symptoms should a man look out for if he is suspecting he has a hernia?
Dr Towfigh
In men, it’s fairly straightforward. If you have a bulging area in the groin, which is basically above the groin crease of your leg, that’s considered a hernia. It can get larger and eventually can grow down towards your testicle, but it’s almost always a bulging area. In rare situations in men, you can have pain in the groin without an obvious hernia. In that case, you need to see a specialist to do a little bit more evaluation into the cause of the groin pain. But almost always in men, you will have some type of swelling or bulging in the groin as a first indication that you have a groin hernia or, like you said, inguinal hernia.
Better Man Clinics
So pain is not usually the big indicator of a hernia?
Dr Towfigh
That’s correct. Pain is usually not the first indicator. Once a man starts having pain, then we usually recommend surgical intervention. But the majority of the hernias tend to be without symptoms and so watchful waiting, which means let’s just see how it goes and not really consider surgery until you have more symptoms, is considered perfectly safe.
Better Man Clinics
For those men that feel a bulge and think that they may have a hernia, what are the red flag signs that would indicate that they need to see a doctor quickly?
Dr Towfigh
Any sort of pain or pulling, pressure, stabbing, or dull ache -some people call it a hot poker- any of those type of symptoms in the groin- tell you that you should see a doctor. Men sometimes also say that the pain can radiate into the testicle, or actually just be testicular pain without an obvious groin bulge. That should also be something to see your doctor for. The emergencies, fortunately, are not common. But when they do happen, they can be severe. If there is a lot of redness and swelling, pain that lasts longer than six hours, bloating or vomiting- those are definitely surgical emergencies.
Better Man Clinics
In doctor speak, we always talk about differential diagnosis, meaning what other conditions could be causing the same symptoms. What other conditions could cause a similar bulge or pain like a hernia?
Dr Towfigh
You can have a bulge in the groin, but that could be not the cause of your pain. There are a lot of things that can cause groin pain aside from a hernia. Some common causes include a hip disorder (labral tear or hip arthritis), a groin pool or just a muscle strain. You could also see a LeBron James type injury with groin pain and some swelling in the area rather than an actual bulge. Some people call that a sports hernia. It’s kind of a misnomer. It’s not really a hernia, but is often seen after some type of extreme sports type activity. Less common causes would be intestinal problems like appendicitis or diverticulitis. Then there’s also the urological realm- it could be things like a varicocele or hydrocele, which are bulges or swelling in the in the scrotum. Finally, the testicles can be the cause of “groin-ish” pain with conditions like epididymitis.
Better Man Clinics
What are the common causes of hernias?
Dr Towfigh
The number one reason for hernias is a genetic predisposition. Whether you’re a male or female, it does kind of get passed on genetically. In fact, the correlation is even stronger in females. Females usually don’t get hernias. But if you have a mother or a sister who had a hernia, you are more likely to have a hernia than if a male family member had a hernia. So genetics is number 1. In the United States, constipation is number two. The straining needed to empty your bowels while constipated generates a lot of abdominal pressure. Anything that increases abdominal pressure makes you more prone to having hernias. However, not everyone who is constipated will have a hernia – often times you need a genetic predisposition as well. Number three is coughing. People with asthma, COPD, smokers, marijuana users all often have a chronic cough. Some people with acid reflux, which kind of irritates your throat, also can have a cough. I highly recommend that people actively treat and not ignore constipation and also coughing. And then, as men grow older, the prostate starts to become a problem. As the prostate gets enlarged, you tend to strain to urinate. Given how many times you go to urinate a day, think of how much you are pushing and straining to empty that bladder completely. That can contribute to having hernias. I always ask that question because I do want all of these risk factors, whether it’s constipation, coughing or enlarged prostate, to be treated before you have your hernia surgery; because those are all contributors.
Now, exercise is interesting. There are multiple studies that show exercise is actually not a risk factor for hernias. It’s a complete myth. There have been great studies in which medical students have had to do different exercises (pull ups, push ups, deadlifts, overhead lifts, sit ups, jumping, and weights) and they measured abdominal pressure. A cough generates many times higher abdominal pressure than any type of weightlifting you do. The only two exercises that did increase pressure, were jumping and leg squats. So,maybe, take those out of the exercise regimen, I’m personally not a big fan of CrossFit. It tends to have a lot of jumping and squatting involved in it. Also, weightlifting is totally fine. Situps, core exercises, yoga, pilates are probably the best. But yeah, weightlifting is totally okay. As long as you’re doing it with good form, and protecting your back, which is part of your core, you’re also protecting the front.
Better Man Clinics
I want to go back and ask a question about this genetic predisposition. Is the assumption that the genetic predisposition just makes the muscles weaker, which makes it possible for the intestine to pop out? Or is there another issue that’s occurring genetically?
Dr Towfigh
It is mostly collagen based. People that have a genetic predisposition to getting hernias tend to have a mismatch of their collagen. There’s weak collagen and there’s more mature (strong) collagen, You want to have more of the stronger, more mature collagen, but it’s the reverse in people that are hernia prone. They tend to have more of the weaker and less mature collagen.. In fact, there are people that genetically have a collagen disorder (the most extreme are conditions like Marfan syndrome or Ehlers Danlos Syndrome) which causes them to be hyper flexible. They are very prone to hernias and pelvic floor disorders or other things that kind of stretch out. We treat those patients very, very differently. But yeah, it’s a collagen problem typically, which is also why nicotine is important. Nicotine prevents collagen from being deposited in an orderly fashion. Let’s say you do surgery on a patient that’s a smoker or uses nicotine regularly. That nicotine will prevent that patient from having a well formed scar and puts them at higher risk of getting poor wound healing and hernias by about 7 times. Nicotine doesn’t cause hernias, but once you have had an incision, it will make you more prone to having hernias.
Better Man Clinics
Can people know ahead of time that they have a genetic predisposition? Or they find out a little too late?
Dr Towfigh
It’s mostly family history. If you know that someone in your family has a hernia, then I would stay away from higher risk activities or risk factors, which are things like constipation, coughing and use of nicotine.
Better Man Clinics
Is there a right time to see a doctor for a hernia? Assuming that you don’t have any of the red flag signs that you mentioned, is it easier or better if you identify and treat a hernia sooner?
Dr Towfigh
I think the importance of seeing a doctor is to be educated as to your own personal risks so that your plan of care is tailored to your needs. Now, I’m a little bit conservative about offering surgery. Usually, I’m not saving a life with surgery, I’m improving the quality of life. So it needs to be worth your while to undergo surgery, because surgery has risks. And anyone who has been watching TV or listening to radio knows that there are a lot of ads about hernia complications and hernia surgeries gone wrong. There are definitely risks with surgery. Sometimes you go to your doctor, and they say, “Oh, you have a hernia, go see a surgeon,”- you didn’t know you had a hernia, no symptoms, it didn’t bother you, you’re living your life perfectly fine. In that situation, it would likely be horrible if you had a hernia repair and then you get symptoms and have pain from the surgery. I’m very conservative in offering surgery to patients that have no symptoms. However, I tell these patients that, with time, that might change. I tell them that, in the future, they have about a two thirds chance of needing surgery. Some people don’t want to wait. They’re okay with surgery at that point in their life because they are healthy or can afford it at that time or their job is in a certain position where they can take some time off or they just are tired of seeing a bulge. But short of that I tell my patients that if they start getting symptoms, or the hernia starts getting bigger, then I recommend that they have surgery.
Better Man Clinics
Let’s say a guy gets referred to a surgeon such as yourself. What would they expect it at that initial consultation with you?
Dr Towfigh
It varies by surgeon. I must say, I have developed super sensitive fingertips so when I examine I tend to do a less invasive exam than the average surgeon unless it’s really hard for me to feel a hernia. In general, the surgeon wants to look at your groin. They may want to also look at your testicle area, but not the penis. We just want to feel the groin from the bellybutton down to top of thigh. The way they teach you in medical school is that, with a gloved finger, you follow the scrotum and the testicle all the way up into the groin crease to find that hole. I find that very invasive and often not necessary. I also have colleagues that are super aggressive about it and put the patient on a stepping stool and really reach -they feel very strongly about getting a really good exam. I just think that that doesn’t change my recommendations. As long as I can feel the hernia, your symptoms are much more important, I think, than the exam. If your symptoms really support a hernia being the cause of your pain, then I don’t need to go digging in there, but I’m in the minority,
Better Man Clinics
Are these exams painful?
Dr Towfigh
No, they’re uncomfortable. They’re a little embarrassing, maybe, but they’re not painful.
Better Man Clinics
Do imaging tests ever come into play with hernias?
Dr Towfigh
Absolutely, imaging plays a huge role. Now, if you have an obvious bulging hernia, and your story is consistent with what hernia pain would be like, then you don’t need any imaging. However, if it’s a small hernia and the story is unclear- maybe it’s your hip and you have a little bit of hip click or your feel a pulling sensation after a certain exercise activity (so maybe it was a groin pool and not necessarily a hernia)- then imaging can help. Ultrasound is the gold standard- specifically a hernia ultrasound, not just any ultrasound- where they have you standing and moving around and pushing to make the hernia more visible. A CT scan helps but only in situations where it’s kind of a larger hernia- you can’t see a smaller hernia on CT scan very well. In my practice, I tend to see the extremes of hernia. If ultrasound doesn’t help me, then I go straight to MRI, which is a very sensitive study for any groin problems.
Better Man Clinics
Are there any nonsurgical options available for treating hernias?
Dr Towfigh
That’s a great question. Every so often, there’ll be a patient that comes to me and says, “I had a hernia once and my doctor told me not to lift anything and stop going to the gym.” So they do all that- and then they gain weight and lose their core strength/function and their pain actually gets worse. So, at that point, they think “Oh, I definitely need surgery”. But they’re reluctant. So I advise them to go back to the gym, lose weight, and get fit. And if they have no symptoms, they really don’t need surgery. Also, in some situations, if you can lose weight and strengthen your core, you can close that hole, or at least support the hole better. It’s technically not a cure, because you still have a hernia. But it’s not symptomatic and may not even be palpable anymore. It may not even be bulging anymore. There are reports anecdotally where you do your exercises and you can’t see the bulge anymore. So that would be a nonsurgical way to do it. It doesn’t work for most people, maybe 5% or less. But in the right patient population, someone who’s gained weight and got worse, they may reverse that situation. That may be a good opportunity.
Better Man Clinics
What about hernia belts that keep the hernia from bulging?
Dr Towfigh
That is called a truss. You can buy them online or at any pharmacy. They’re a little bit medieval in their technology. There is one gentleman who has a hernia who’s invented something much softer, called the “comfort truss”. I do like his line of trusses. But trusses only help with symptoms. So if you have a big hernia, and you are a security guard or a surgeon, you’re standing all day and it is bulging throughout the day, becoming heavier and heavier. The truss holds the hernia in and, so, you’re less likely to feel that kind of dull, achy pain, and are able to have a better quality of life, usually during work. So that’s all it does. It doesn’t cure hernias. It doesn’t make them smaller. It just prevents symptoms. Also, if you are not a good candidate for surgery, a truss would be a good option.
Better Man Clinics
What are the surgical options for treating a hernia?
Dr Towfigh
There are two categories: open and laparoscopic (minimally invasive). Open surgery involves a scar in the groin usually about a little over two inches. Laparoscopic surgery involves multiple small scars about a half an inch or less (a third of an inch) each. Those are the two categories -there’s also the consideration of whether the surgery is performed with mesh or without mesh. All of those variations can be combined: open with mesh, open without mesh, laparoscopic with mesh, or robotic with mesh. I also offer robotic without mesh, which is a new technique. So you have lots of options. There are pros and cons with each – the recovery rates are different, the recurrence rates are different. The level of pain is different and long term recurrence rates are different. And then lastly, some need general anesthesia while others you can just do with local anesthesia. I usually talk with my patient to try to figure out what’s important to them. If they’re an athlete, and they just want to be able to go back and do as much exercise as they want to as soon as possible, then laparoscopic with mesh would be the option. If they are super thin, not athletic and don’t want mesh in them or they have an autoimmune problem or they’re afraid of mesh, then open repair with tissue would be another option. So there are a lot of options.
Better Man Clinics
What is the primary goal of all of these different types of hernia surgeries?
Dr Towfigh
The primary goal is to prevent contents from going through the hole. You can do that by closing the hole or patching the hole. Patching is always with mesh. And closing is always the tissue repair. And there’s philosophies about each. We think that if you close the hole, you’re actually making it tighter, so it hurts more and it can tear more- but you’re not using mesh. So it’s a matter of whether you want to take that risk or not. The risk of recurrence (of closing) is somewhere between a couple of percentage points to like 15% depending on the skill of the surgeon and the risk of the patient. Patching is considered the more modern approach. We think that when you patch something, you’re less likely to tear it because there’s no tension. If you think about it, when we were kids, it wasn’t cool to have holes in jeans. Instead, there were those iron on patches. And also they used patches for the elbows of sweaters. No one sewed holes in those areas closed, because it would look ugly and tighter. You patched it. So that’s the same concept for groin hernias: patching. We bring in something stronger because, as we discussed earlier, your tissue is not as strong (the collagen and scar tissue is not as strong) and we can’t rely on your own natural tissue. For excellent results, we bring in something in the form of a patch that buttresses it. Patching is considered the favorite approach in the United States.
Better Man Clinics
You had mentioned that patching is done with mesh. What is mesh made of?
Dr Towfigh
There is a very wide range of materials. Typically, when we say mesh, it’s synthetic. It’s something that’s manmade- it’s often polypropylene (which is a type of plastic or polyester) which is a knit and it’s synthetic. It’s a foreign body. There are biologic meshes which may be used but they are absorbable. It can come from any type of cadaver, whether it’s human cadaver or animal cadaver. And then there’s synthetic absorbable, which is like a whole different world- also absorbable, but more of a synthetic material. And then there’s hybrid. I think hybrids are like the next best thing because they don’t include as much synthetic material. They are mostly biologic (that is absorbable) but just synthetic enough to prevent a hernia from coming back when the biologic absorbs. So I like hybrid meshes. But the point is, people talk about mesh and there’s a lot of negative press about mesh and lawsuits against mesh, but there’s so many different types of mesh. Not all meshes are the same.
Better Man Clinics
People obviously get a little concerned when it comes to foreign bodies like meshes implanted into their bodies. Is that a big issue that you go over with patients? How significant are potential reactions to the mesh?
Dr Towfigh
For hernia surgeons, it’s a big issue, because we must discuss this with patients. They already come into the office understanding a lot about the controversy surrounding mesh, and they’re a little bit afraid of mesh. So it’s more a part of our standard practice to discuss the pros and cons of mesh with every patient than it used to be. The good news is that, because there’s so much attention paid to it, I think it also allows us to reevaluate what we’re doing. My personal opinion is that we are overusing mesh. We don’t need to put mesh in every single patient for every single hernia, which is pretty much where we were going in the United States. Tailoring is important. For some patient, an extra 5% risk of recurrence is totally fine. And if they recur, then look at the mesh. So there are a lot of discussions you can have. But I’m very interested in all these mesh reactions. And I’m very sensitive to it because I do treat people that legitimately have actual physical manifestations and reactions to mash. I’ll give you a great story. So I had a patient who had a polyester allergy. He actually used to work in a shipyard where there’s all this polyester resin in the air, and his eyes would start watering and then he would start wheezing – truly a severe polyester allergy. As I mentioned earlier, there are meshes that are made of polyester. The poor guy had polyester mesh implanted in him. Can you imagine? I have pictures- it’s pretty amazing. The exact outline of the mesh can be seen at the skin level: beefy red and painful. The treatment for that is just to remove the mesh. I did and he did fine. But you know that is a real allergy. I think that we don’t know enough about who reacts to these things(meshes). We do know that there’s a very small fraction (a fraction of 1%) that truly react to these(meshes). We don’t know whether this is a western world thing. We don’t really see people from second to third world countries having mesh reactions like this. Are we exposed in our world to a lot of plastics and artificial stuff in the United States, for example? Are we sensitized and, when you put an implant into us, do we then react to it? That is another question that hasn’t been answered. I have my own theory. I think that the industry has changed their recipe of how they make meshes and the actual resins that they use to make their mash is different and has more impurities in it than the original kind. Are these newer, cheaper manufacturers using more impure stuff, and now we’re putting it in the body and reacting to it? There’s a great 60 Minutes episode about transvaginal mesh and how the properties have changed. The reactions went up. So it’s real- it’s seems to be increasing over time. It’s still a very small percentage of people but it is real.
Better Man Clinics
Earlier you mentioned surgical options for hernias like open, laparoscopic, and robotic procedures. Understanding that it depends on the patient and the situation, is one of these procedures generally superior to the others?
Dr Towfigh
I’ll tell you that if I had hernia surgery for myself, I’d probably choose a laparoscopic procedure with mesh. It’s secure. It’s easy. It’s the lowest risk of chronic pain of all the techniques and it’s tried and true. Of course, obviously choose a surgeon to perform that procedure that does it for a living. If I were super thin and maybe had some autoimmune family history, then I would err on something less synthetic and more of a tissue-based repair. If I were a huge guy or like a construction worker, I would err on doing a mesh-based repair. I’m a big fan of laparoscopic. The only reason I don’t talk much about open surgery with mesh is because that has been shown to have, of all the techniques, the most chronic pain associated with it. But if you’re morbidly obese or you’re not a good candidate for general anesthesia (that’s your older patient), it is totally legitimate to do a nice open mesh-based or tissue repair, which was actually invented in my hospital Cedars Sinai in Los Angeles, believe it or not. It is a good repair for a sicker, more elderly patient because it does not necessarily require general anesthesia. My big issue is that I think that most surgeons only offer one type of procedure. They’re really good at one or, maybe, two techniques. They don’t offer the range of options. So, as with any surgery, I recommend people get second opinions. I see young kids, young men, with hernias on both sides, that get them repaired via the open technique with mesh. That is so like 1980s -that should be done laparoscopically. However, it is sometimes just not offered, so you don’t know.
Better Man Clinics
So that’s an important question. When you’re going to a surgeon, what questions should you be asking? What should you be looking for in terms of the bona fides? How would you assess their skill or experience?
Dr Towfigh
Most of us believe that the outcome from hernia repair is very strongly associated with the surgical technique of the surgeon. I know that all the lawsuits are focusing on the industry, and they’re suing the mesh companies, but the complications that you see are really because of surgical technique or the surgeon rather than the actual mesh design. My recommendation is that your surgeon should have an interest in hernias – they should care about this problem. Usually, people who have an interest perform hernia repairs as a third to a half of their total case volume. The average general surgeon is trained to perform hernia surgery. Any general surgery practice will probably be doing hernias. But if they’re doing breast and colon surgery as well as hernia surgery and, if they are a community based general surgeon, most likely they don’t care about their hernias. So therefore, it’s kind of like, “oh, well, it’s just a hernia.” I feel that when you have that kind of attitude, you’re less likely to do a perfect job. Whereas if you really like it, then you probably are doing more hernias and about a third to half of your cases are hernia surgeries. A great resource is the website of the American Hernia Society. On the site, there is a “find a surgeon” tab where you can look for surgeons that are interested in hernias. They’re not necessarily specialists, but at least they have an interest.
Better Man Clinics
What are some other good screening questions to ask a potential hernia surgeon? Should you ask how many hernia operations they have done across their career? How many they perform a year? What percentage of the practice is hernias? Do they need to dive into that or is it basically what you mentioned before – what is the breadth of surgical techniques that they offer?
Dr Towfigh
You should ask yourself a question -would you rather come to me (I do approximately 300 cases a year -only hernias) or someone who does like 1000 cases that are done really poorly? You know, I feel like the number is not that important. It’s more important that they offer the breadth of repairs. That means that they can tailor the procedure to your needs. That’s number one. I would ask questions like “So do you offer open? Would you offer tissue repair? Would you offer laparoscopic or robotic? And why or why not?” And then, secondly, I would ask what percentage of their practice is dedicated to hernia repair. I think the percentage of the practice dedicated to hernia repair is more important than the total number of cases. You don’t want to go to someone who is a high volume surgeon but who is low quality. You want someone to really like and enjoy what they’re doing.
Better Man Clinics
What are the risks of a hernia surgery on a high level?
Dr Towfigh
On a high level, the first risk is that the hernia will recur, that it will come back. That can happen with any procedure you choose. There is always a risk that it comes back. The risk is related to your own body tissue and the type of repair that you choose as well as what risk factors you come in with. The second risk is chronic pain. Pain that occurs after 3 months since the surgery is considered chronic pain. The rates of chronic pain obviously get smaller after one year. The causes of the pain can be the mesh (and inflammation from the mesh), excessive tightness of the repair, and nerve damage from the operation. In men, there tends not to be many issues with sexual function; that should really not be a problem. There is a question about fertility- whether fertility can be affected by hernia repairs, especially when you use mesh. That is a controversial question. In general, the answer is no. But if you’re really unlucky, and you have surgery for hernias on both sides and there is damage to the vas deferens on both sides as a result, that may be a possibility.
Better Man Clinics
What are the typical recurrence rates after hernia surgery?
Dr Towfigh
You want your recurrence to be under 1%. For inguinal hernias, the expected recurrence rate for almost every technique is under 1%.
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And if you’re in that lucky 1%, what happens then? Do you have to have the surgery redone?
Dr Towfigh
Yes. Eighty percent of what I do is revisional. So obviously, there’s a market there, mostly because we do like a million hernia repairs a year in the United States alone. There’s a certain percentage of problems that need to be addressed. If you initially had an open repair, then the recurrence is usually fixed laparoscopically or robotically. If you initially had a laparoscopic or robotic operation, and you had a recurrence, then we do open, This is in order to work in more
“virgin” tissues without scar tissue.
Better Man Clinics
What percentage of patients undergoing hernia surgery later experience chronic pain?
Dr Towfigh
That’s considered to be 12%. The range is between 5% to 20% but we think that 12% is more representative. That’s a real number, because 12% of a million is 120,000. That’s not a small amount.
Better Man Clinics
So if you’re in that 12% and you do develop a chronic pain, what are the options for you? How is the chronic pain managed?
Dr Towfigh
A term like chronic pain doesn’t explain anything. Chronic pain could be because you have a hernia recurrence. Or it could be that the mesh is folded (you can feel like a folding or balling up) or that a nerve is injured or that the mesh is eroded in some area. Each one of those scenarios has a different treatment. Not all of them are surgical. If you have a nerve issue, sometimes a nerve block or nerve ablation alone is all you need. If you have a hernia recurrence, that requires surgical intervention. If its just inflammation from the mesh, sometimes that gets better over time, like over a year. So you just have to be patient. That’s where the detective work comes into play because you don’t want the patient to suffer from chronic pain for a reason that’s totally treatable. You also don’t want to over treat patients and go in and take everyone’s mesh out. There are surgeons out there that kind of prey upon patients that claim that they have pain. And what they do is they keep taking mash out saying all the pain is mesh pain. That is not a very tailored approach. A lot of people are being hurt by going to those surgeons.
Better Man Clinics
It is reassuring to know that there are treatments available for the 12% of patients that develop chronic pain after hernia surgery.
Dr Towfigh
Right and the treatments for the chronic pain result in a cure for 85% of patients.
Better Man Clinics
Many patients ask about the type of anesthesia required for hernia surgery. You had mentioned that for laparoscopic and robotic surgery, general anesthesia is required. Is that the case with open surgery as well?
Dr Towfigh
I almost always do open hernia repair under local anesthesia with sedation.
Better Man Clinics
Regardless of what type of hernia procedure is performed, is it usually outpatient? Do your hernia patients go home the same day or do they have to be hospitalized?
Dr Towfigh
Every type of hernia procedure performed in the United States is usually outpatient.
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After any type of surgery, there’s going to be some pain and discomfort. How much would you expect after hernia surgery and for how long?
Dr Towfigh
It depends on the technique. It also depends on the surgeon. If you have a heavy handed surgeon, you can get a lot of swelling and bruising and bleeding in the area which can be very painful. What I tell my patients is that, for laparoscopic surgeries, there are usually 3 days of recovery and, for open surgery, it’s about one to two weeks -one week for repairs done with mesh and two weeks for those done without mesh. So that’s the range – several days to several weeks.
Better Man Clinics
By recovery time, do you mean in terms of just pain? Can patients go back to work within that period of time.
Dr Towfigh
By recovery, I mean you’ll be taking pain medication, and that usually only involves Tylenol and Advil or Aleve. I don’t usually give narcotics. Some people give narcotics but I think that there’s really no reason for that for groin hernias.
Better Man Clinics
What about postoperative restrictions?
Dr Towfigh
The national and international consensus is that no restrictions are necessary after hernia surgery.
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What type of surgery is better from a cosmetic perspective?
Dr Towfigh
Yeah, that’s a good point. I have treated a handful of male models and porn stars. Scarring is important to those two groups. For the laparoscopic procedure, I can hide the hole in the belly button. That’s a non issue. I can hide the other hole in the pubic hairline. The third hole (which is the middle one) is a tricky one. And for the laparoscopic procedure, I tend to do a mini lap so it’s three millimeter trocars instead of five millimeter – that’s the most cosmetic I can get it. Now if you’re not a porn star and are just a male model, you are going be covering your groin area. Sometimes just having a little two centimeter incision in the groin is technically more cosmetically acceptable than having anything on the belly. I’m a big fan of laparoscopic surgery because you can play around with your scars and make them look more cosmetically appealing. With robotic surgery, you can’t really fudge where the scars are and they’re a little bit bigger than with laparoscopy. I do not offer robotic surgery for those with cosmetic concerns. I really do robotics mainly for revisional complicated cases where, by that time, they don’t care about what their scars look like.