DEAR DR. ROACH: I am a 70-year-old male with a large inguinal hernia on the right side. I have consulted two different surgeons, and both surgeons recommend taking care of the condition at the earliest convenience.
The surgeon who specializes in robotic surgery recommends laparoscopic surgery with three small incisions. He also recommends surgery on the left side because he detects a weakness; he says if you have a hernia on one side, you are likely to get one on the other. Another surgeon recommends open surgery due to the size of the hernia and flatly states that the left side does not need surgery.
What is your opinion of laparoscopic versus open surgery as both seem to have pros and cons? What is your opinion on preventive surgery for the left side? — A.H.S.
ANSWER: On the question of open versus laparoscopic repair of inguinal hernias in men, the data show that laparoscopic surgery has faster recovery times and less pain. Among surgeons who have expertise in both types of surgery (250 laparoscopic surgeries were required to be considered sufficient experience), the complication rate was the same. The larger size of a hernia isn’t usually a reason to avoid laparoscopic surgery, so I recommend a surgeon who has expertise in laparoscopic surgery.
On the question of simultaneously repairing the other side, it can usually be done on both sides laparoscopically using the same incisions, which makes things easier and prevents more scars later on if the hernia does become symptomatic. But since you haven’t told me about any symptoms on the left side, I personally would not recommend that a patient get it done at the same time even if it is easier because you may never need to get it done.
DEAR DR. ROACH: You recently answered a question regarding omega-3 fatty acids (EPA and DHA) and heart disease. Do you have any research findings on the use of oral supplements with high levels of EPA and DHA for dry-eye problems?
After experiencing severe dry eye issues after cataract surgery several years ago, I was recommended a specific supplement with 2,400 mg of omega-3 fatty acids (1,680 EPA and 560 DHA) by my ophthalmologist. The cost of these supplements is very high, and although I have experienced some relief, I am wondering if there are alternative supplements that might provide the same results at a lower cost.
During this time, I have also had a procedure called intense pulse light (IPL) therapy, consisting of six treatments that were very painful and only provided temporary relief. — G.Z.
ANSWER: There have been large studies comparing the same treatment you are prescribed against a placebo pill containing grapeseed oil in people with dry eyes due to the gland that produces the oily lubricant of the eye (the meibomian gland). Unfortunately, there was no significant difference in symptoms between the people who took the omega-3 acids and those who took the placebo.
Another study used the same omega-3 supplement in people with dry eyes who had not responded to other therapies and didn’t find any significant improvement compared to an olive oil pill. Although omega-3 supplements are safe, they are not better than other oils when subjected to careful scrutiny.
