Hernia – not everyone can elect for surgery

The apparent secrecy around the process of being able to be permitted to have surgery creates an uneven playing field. Maybe I was lucky.

Hernia – not everyone can elect for surgery. This is about my experience and what I then learned from friends. It is time there was fairness in the ability of patients to elect for surgery.

In October 2019, whilst on a walking holiday, I developed a hernia. The feeling of a large painful lump above my right groin was nothing like I had felt before. The thing is, having no previous knowledge or experience of what a hernia is, I was completely ignorant of what my medical problem was. The walking holiday was soon over and I was then able to enter into denial and carry on with my normal life.

And then on new years’ eve – two months’ later – it happened again. I had spent the evening with friends and family and celebrated the new year by being in agony and unable to walk, due to the same painful lump. My sin, this time was walking in out of bars for four hours.

With much insistence from my sister I called my GP. I had a male GP because, as he explained to me, that way I had a GP attending to my male physical needs. Yet when I described my symptoms to him, his response was a kind of verbal ignorant huff. I was asked to carry on and see what happened.

Thanks to my GP I still did not know I had a hernia. I play squash, I run and I go to the gym. I was able to continue my fitness regime as it was typically contained within half an hour. But occasionally my exercise tipped over half an hour and the pain re-emerged. After some research I called my GP again in March. It is a hernia, I said to him. His response was telling, he acknowledged my medical problem as if he knew all along. If I had seen him in a surgery I could looked into his eyes and seen the truth.

From March through to my surgery in September – about 20 weeks – I was able to pass through the stages of the meeting with the consultant, the scan and then the booking of the surgery without fuss. The only delay was the date of the surgery being delayed by a week due to another patient needing an amputation. Can’t complain about that.
I had an inguinal hernia. Hernias occur when an organ breaks through the muscle or tissue wall that was holding it in place. The surgery involved a flap being peeled back over the hernia and a piece of mesh is stapled or glued to the weakened area in your abdomen wall to strengthen it.

Around 570 0000 hernia mesh operations have taken place in England over the past six years, figures from NHS Digital show. Mesh is recommended for the repair of most hernias when prevention of recurrence is the main reason.

What surprised me after my surgery was that I then discovered from male friends that elective surgery is not as available as it should be. Whilst my GP had appeared to deliberately delay my surgery one friend had been told by his GP to live with it. Whilst our circumstances are slightly different we are roughly the same age and physical condition. Yes it is possible in some circumstances to live with a hernia is this not meant to be a discussion between the patient and the GP?

Are other factors may be at play here –such as the subjectivity of the GP or the rationing of funds in that area, or the bureaucratic process for making a hernia referral that is putting GPs off?

Allison Pearson in the Daily Telegraph gives the example of a London GP, referring to long delays meaning their condition has now deteriorated. “They want to work, but they can’t until they have surgery (e.g. hernia). In the good old days, Dr Clare used to dictate a referral letter to a named consultant at the local hospital. The patient swiftly received an appointment. Today, the GP is not allowed to refer directly at all. For many specialties, Clare has to use a triage system known as SPA (single point of access).”

Finally there is the impact of the COVID pandemic. There was a 38.6% reduction in elective surgery in 2020 (inguinal Hernia wait times in the NHS post COVID19.)

The delay to having hernia surgery can cause problems both for the individual and for the NHS.
Even if you aren’t having any problems with it – with normal wear and tear, exercising, lifting, physical activity – that small hernia, over time, will start to become larger. Over ten months from discovery to surgery my hernia tear had become larger. A larger hernia is harder to repair.

The seriousness of a hernia cannot be underestimated. Whilst, over the period of two months I may have fully recovered there remain risks. Mesh is an implant. It carries with it “the risks of any implant, including invoking a foreign-body reaction, a risk of implant infection, potentially a source of chronic pain and, in some, possibly inducing a local or systemic immune reaction.”

The complication rate may be between 12% and 30%. An investigation by the BBC’s Victoria Derbyshire programme found that “up to 170 000 patients who have had hernia mesh operations in the past six years could be experiencing complications, yet NHS trusts in England have no consistent policy for treatment or follow-up with patients.“ On the programme patients who had had hernia mesh operations talked about “being in constant pain, unable to sleep, and finding it difficult to walk or even pick up a sock. Some patients said that they felt suicidal.”

Hernia mesh complications may have affected up to 170 000 patients, investigation finds | The BMJ

The apparent secrecy around the process of being able to be permitted to have surgery creates an uneven playing field. Maybe I was lucky because my exercise regime was specifically cited as a reason for the surgery – should that be the case? Is it not time for quality of life to be accepted by GPs as a good enough reason for surgery?

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