Late presentation of surgical conditions is not only in cancer cases, but in other non-cancerous conditions as well. Most common is hernia. Our people tend to keep their hernias 'secret' till the time they couldn't hide it anymore. Either it is too big or it gets obstructed or strangulated.

There are the 'common' presentations;

A 42 year old man

A 63 year old man

I could not imaging how these people get on with their life, having to carry huge things in between their thighs. How did they hide this from other peoples? Once I saw a man in a 'kenduri' who had to adjust something in his sarong in order to sit down and eat; and the way he did that, it must be a huge thing.

The usual hernia that you see bulging in the groin (called bubonocele-type) or that of inguino-scrotal type is usually repaired in a relatively simple and fast operation; herniotomy (in children and adolescents), herniorrhaphy (the weak area is sutured to strengthen it) or hernioplasty (meshes used to strengthen the posterior wall). This operation usually never take more than one hour to do and in my hospital it costs between RM4000 - RM5000. Huge hernias are of course more difficult to repair and more costly.

This is a hernia that I repaired two years ago. It tooks the man 40 years to come, seven days in the hospital including two days in ICU, and RM35,000 in hospital bill.

A 57 year old man

Almost the whole bowel, from the jejunum to the sigmoid colon were in the hernia. X-rays taken before operation showed bowel shadows lie near the knee joints.

Is there a way to make patients come early?

Probably the goverment (Ministry of Health) should start putting billboards on the highways with a picture like the above with a caption " JANGAN TUNGGU SAMPAI MACAM INI" or "MACAM MANA NAK BUAT KERJA KALAU INI MACAM!"