NIS

The Inoperable Hernia

What makes some hernias inoperable?

It happens all too often that an uninsured patients is told that it is alright to just live with their hernia. Doctors are assuming that these patient have no way to get their hernia fixed and think that they are doing their patient a favor by not having them worry about something that they think that they cannot do anything about. This is not the right thing to do because it encourages neglect where patients might otherwise find a way to get their hernia taken care of.

The Untreated hernia is a topic that we cover elsewhere. The inoperable hernia is a special case that disserves additional consideration.

An inoperable hernia is a hernia that cannot be fixed with reasonable safety. Factors that affect this include the size of the hernia, obesity and the health of the patient.

Small hernias are by far easier to fix than large hernias. Since hernias only get bigger with time waiting may result in unacceptable medical consequences and should be discouraged.

Some hernias that are large may be fixed with reasonable safety but only in the hospital inpatient setting and not as an outpatient. With hospitalization the costs go up dramatically and this is another reason why we encourage uninsured patients to get their hernia repaired sooner rather than later.

As hernias get bigger there is a loss of what is called "eminent domain". This means that once the abdominal viscera occupy a hernia outside of the abdominal cavity for a length of time the abdominal cavity irreversibly shrinks and the viscera can never be returned again into the abdomen. Attempts to repair these hernias result in elevation of the diaphragms and embarrassment of respiratory function, that is, suffocation.

Patients that have health problems or obesity may have small hernias fixed safely. For these patients the risks of surgery go up dramatically with the size of the hernia.

At No Insurance Surgery we advise all patients to get their hernias fixed as soon as they can. We have to turn down some patients because we feel that outpatient surgery is inappropriate for them. We may tell these patients that they can still get their hernias fixed as an inpatient and then try to help them to get governmental assistance to cover the prohibitively expensive cost of inpatient hospital surgery.