Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Hernia Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
In short
Families often arrive having already decided that an operation at 78 is out of the question. They ask only how to manage without one. That instinct is reasonable, and sometimes it is right. But the comparison being made is usually the wrong one.
The choice is rarely between an operation and nothing. It is between a planned operation now, in controlled conditions, and the chance of an emergency operation later, in an eighty-year-old who has been vomiting for a day.
Those two operations carry very different risks. The second one is what watchful waiting is accepting a share of.
Age on its own is a poor guide to surgical risk. What counts is heart and lung reserve. Frailty. How much you can do for yourself. What you eat. Memory.
An active 82-year-old who lives alone often copes with a planned hernia repair better than a frail 68-year-old whose heart failure is not well controlled.
A proper check looks at how far you can walk. At heart and lung disease. At medicines, above all blood thinners. At memory. And at who is at home afterwards.
Seeing the anaesthetist before the decision, not after it, is often the single most useful step.
Two caveats apply even here. Femoral hernias are generally repaired whatever the age, because their risk of trapping bowel is high. And a hernia that starts causing symptoms has changed category. The decision should be looked at again, not left where it was made.
What the assessment actually looks at
| What is checked | Why it matters | What to bring |
|---|---|---|
| Exercise tolerance | How far you walk before stopping is the clearest simple guide to reserve | An honest account of a normal day |
| Heart | Heart failure and rhythm problems change the anaesthetic plan | ECG, echo and any cardiology letters |
| Lungs | A chronic cough loads the repair and slows recovery | Inhaler list, any chest X-ray |
| Medicines | Blood thinners need a plan agreed with the prescriber | Every box, not a list |
| Frailty and memory | These predict delirium and a slower recovery more than age does | Who is at home afterwards |
| The hernia itself | A femoral or narrow-necked hernia shifts the decision towards repair | Any scan already done |
For an older patient, bring the cardiac and respiratory records to the first consultation. They decide more than the examination does.
Watching should be an active plan, not a discharge.
That means the patient and the family know the warning signs. It means they know which hospital to go to, and that presenting early is what decides the outcome. It means a review if anything changes.
And it means the decision is written down, so the next doctor can see it was a decision rather than an oversight.
No. Fitness decides it, not age. Heart and lung reserve, frailty and how much you can do for yourself all say far more than the year of birth.
An open groin repair can often be done under a local or regional block. That is frequently the route chosen where a general anaesthetic is the main worry. Keyhole and robotic repairs need a general anaesthetic.
Not always. Leaving it accepts the risk of an emergency operation later. In an older patient that carries a much higher risk of death than a planned repair. A symptomless groin hernia with a wide neck is where watching makes most sense.
This is managed, not a barrier. The plan is agreed with the doctor who prescribed them, weighing the bleeding risk against the reason they were started. Never stop them without that discussion.
Yes. Femoral hernias trap bowel far more readily than groin hernias above the ligament. So they are generally repaired when found, even where a similar inguinal hernia would be watched.
The main page on this site is robotic hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Shah's Gastro, Cancer & Robotic Surgery Centre
Apollo Hospital, Bhat, Gandhinagar
Gota OPD, Ahmedabad
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