The hernia debate: What is the best cure?

Hernias are an ancient ailment, and modern medicine still debates the best ways to repair or live with them. One of the earliest references appears in the Ebers Papyrus, an Egyptian medical scroll from around 1550 BCE. The treatment for hernias was to push them back into place, in techniques described by Hippocrates. Galen, a Greek physician to gladiators and Roman emperors, had a preference for treating “surgical conditions by means other than the knife.”

One can only imagine. An enduring piece of hernia lore is the truss. A truss was essentially a belt with a pad designed to apply pressure to the protrusion. Trusses were made of leather, metal, or fabric. Some people wore them for decades. Apparently, Benjamin Franklin, suffering from a hernia, customized the design of his own truss for improved comfort.

Look no further than to Medieval Europe to find the most absurd so-called cures.  Some believed that passing through a split tree trunk, literally crawling through it, could cure a hernia. The tree would then be bound shut, as though healing the patient by analogy. Odd times. Early hernia surgery was crude, painful, and often fatal. Before the late 19^th century, the combination of infection, lack of anesthesia, and poor anatomical knowledge made abdominal operations deeply dangerous.

The turning point came with Eduardo Bassini, an Italian surgeon who, in the 1880s, meticulously studied the groin’s anatomy and introduced a systematic way to reconstruct it. His technique, though modified many times since, is widely regarded as the first reliable hernia repair. The 20^th century brought the introduction of surgical mesh. Using mesh allowed surgeons to reinforce weakened tissue and reduce recurrence rates. It was heralded as a breakthrough, though in recent decades it has also sparked debate and litigation. Mesh can be enormously effective, but as with many medical advances, its success is not guaranteed.

Today, many people delay treatment out of fear, embarrassment, or the hope that the problem might resolve itself. They can result from lifting, chronic coughing, pregnancy, or even genetic predisposition. They are democratic: they affect the young, old, athletic, sedentary, cautious, and risk-takers alike.

In the internet era, the ancient impulse to treat hernias at home has been revived by self-proclaimed experts posting videos of DIY abdominal wraps, self-reduction tutorials, and miracle cures. Some echo centuries-old remedies: compresses, belts, or herbal treatments. Others are newly imagined, drawing on the vast creativity of people in online forums. The fact is, hernias can occur in many different parts of the body, from a variety of causes, and with a wide range of implications, sometimes inconsequential and sometimes fatal. So go and see a doctor to determine the best treatment for you.

Readers often write requesting information about what the take of Dr. W. Gifford-Jones was on one medical issue, or another. He had a much appreciated “no nonsense” philosophy. From reading his column for years and years, he was known and trusted. Well, you can still find what he had to say on topics like hernias. Go to www.docgiff.com and type the keywords of interest into the search engine (a little magnifying glass icon in the top right of the page).

For example, type “hernia” and you’ll get access to columns on “How to decrease the risk of large bowel hernias,” “If it’s partly broken, should you fix it,” and advice to “Think twice about hernia surgery” Columns since around the year 2000 are posted. I’m posting more and more of the older archive of columns too. Among them, some gems!

This column offers opinions on health and wellness, not personal medical advice.