Perhaps people are afraid of surgery, perhaps they are poor with priority being food and shelter rather than health or probably negligent towards health. I have seen people living with groin hernia for years together, and not undergoing treatment. It may be alright for poor and those who are afraid of surgery, to go on deferring treatment. But, I do not find words for those, whose cost of treatment is borne by the organizations where they serve, to come late for a hernia surgery and even, wait for a complication to develop necessitating an emergency surgery. It is perhaps the security and easy availability of hospital care, that the institution provides free of cost. They take it for granted that when ever and in whatever stage they come to the hospital, will be taken care of. They do not understand the increased risks associated with it.
A patient of groin hernia for seven long years comes to the surgeon for treatment. He also suffers from chronic bronchitis. We know that, any disease causing increase in intra-abdominal pressure may cause a hernia to develop anywhere, and groin is the commonest place for this. Those diseases are, chronic bronchitis and diseases causing obstruction to flow of urine. So, here the patient is advised to control bronchitis first, as a surgery may be a fail, if there is cough during the post operative period. Even the sutures may give way.
The person listens carefully only to report after about one year, again with same cough; but this time, associated vomiting and a diffuse abdominal pain. He explains this delay, to be due to the advice of the surgeon to come after control of bronchitis by the medicine specialist, something which will have few takers. The patient this time, found to have an irreducible hernia. A hernia may progress from irreducible, obstructed, strangulated to frank gangrene of the contents as a complication. The complications in a hernia, though can not be predicted; those coming out through a narrow opening are predisposed to it. The contents of hernial contents were reduced in an outdoor setting with an advice to the patient to come for definitive surgery quickly after control of bronchitis. The patient leaves with affirmation, and again not seen for many days.
After some days, again he come up with an obstructed hernia; a stage ahead of the previous complication, the irreducibility. Now, an emergency surgery has to be performed to save the contents from a death trap, prevent gangrene and save the life of the patient. I do not understand the logic behind the behavior of the patient in this bizarre manner. Obstructed hernias are usually taken up under general anesthesia. But, bronchitis increases the anesthetic risk many fold. It was decided to take up the case under local anesthesia and sedation. Intra-operatively, a toxic hemorrhagic fluid is found in the hernial sac; with the contents free from gangrene. The operation was concluded uneventfully. Now, the bronchitis part has to be watched carefully, so that, it does not cause a problem in the smooth recovery.