إمتى أعمل عملية الفتق؟ ليه الإصلاح بدري أفضل وتوقيتها بعد الولادة | When Should You Repair a Hernia? Why Early Repair Is Better, and Timing After Pregnancy
بودكاست - الحلقة الثانية | Podcast: Episode 2
في الحلقة الثانية من بودكاست «مع د. محمد حسام زيدان»، د. محمد بيرد على جملة بنسمعها كتير في العيادة: «الفتق كده كده هيرجع، فخليني أستنى». بمثال الستارة بيوضح إن الخرم الصغير اللي بيتخيط بدري فرصة رجوعه أقل بكتير من خرم سيبناه يكبر، والفتق نفس الفكرة: كل ما اتصلح وهو صغير، بالشبكة المناسبة في الطبقة الصحيحة وبعد الاحتياطات زي إنقاص الوزن، كل ما فرصة رجوعه قلت. وبالنسبة للفتق بعد الولادة، الأبحاث مختلفة في التوقيت (6 شهور، سنة، أو سنة ونص)، ود. زيدان بيفضل الانتظار من سنة لسنة ونص بعد الولادة. | In the second episode of the podcast "With Dr. Mohamed H. Zidan", Dr. Zidan answers something patients often say in clinic: "The hernia will come back anyway, so I'll wait." Using a curtain analogy, he explains that a small hole stitched early is far less likely to tear again than one left to grow, and a hernia is no different: the earlier it is repaired, with the right mesh in the right layer and precautions such as weight loss, the lower the chance it comes back. On hernia after pregnancy, studies differ on timing (6 months, 1 year or 18 months), and Dr. Zidan prefers to wait one to one and a half years after delivery.
Key Takeaways
Full Transcript
Dr. Zidan: That's the patient who has already taken the step and had the operation. There's a saying I hear: since the hernia will come back anyway, I won't have laparoscopy or open surgery. That's true; a lot of people come to the clinic saying, "I've had the hernia for 20 years, and I said I'll have it done when I'm 50 or 55, because the hernia will come back anyway." But let me give you an example: this curtain, say. If it has a small hole or a small tear, what's the fix? We stitch it. Let's put two holes in the same curtain. The first hole was tiny when it appeared, and we stitched it right away. The second hole we left alone, with people coming and going, a child opening the curtain, someone pulling it, and so on. The tear will get bigger, and then we stitch it. Now let's compare the two holes we stitched: which one is more likely to come back or tear again? The big tear that was stitched after it grew. That's exactly what happens with a hernia, because a hernia is a tear just like the tear in the curtain; it's a tear in the abdominal wall. If it's still a small hernia and we repair it right away, the chance of it coming back is very low, especially if we use the right techniques: a mesh placed in the right layer, at the right time, having taken the precautions that reduce recurrence, such as getting the patient to lose weight before the operation and choosing the right time for a woman to have the operation after pregnancy. All of that reduces the chance of it coming back. But if we took the same precautions for a patient with a large hernia, the chance of it coming back would be much higher than with the small one. The earlier we do it, the better the result.
Host: You just said that for a woman who has given birth, we choose the right time. When should she have the operation? Isn't it better to have it right after delivery?
Dr. Zidan: No, it's not better to have it right after delivery; we have to wait a while. There are many differences in the scientific research on when to operate after delivery. Some studies and recommendations say it's better to wait six months before operating, others say a year, and others say a year and a half. Whenever scientific opinions differ and there's no consensus on a single view, the doctor can choose based on his own practice and experience. Personally, I prefer to wait at least a year after delivery, and I even tell patients a year and a half, so a year to a year and a half after delivery, and then we can do the operation.