Hernias: Are they harmful?

Transcript

Scott Webb (Host): Hernias are very common and oftentimes misunderstood, or maybe even misdiagnosed. Joining me today to explain hernias, why we get them, and the various treatment options, is Dr. Andrew Schneider. He’s a General Surgeon with Prisma Health. This is Flourish, a podcast brought to you by Prisma Health. I’m Scott Webb. So, Dr. Schneider, thanks so much for your time today. We’re going to talk about hernias, which are probably fairly common for most folks, but as we get rolling here, just a baseline question. What is a hernia exactly?

Andrew Schneider, MD (Guest): A hernia in its most basic sense is a hole. The exact medical definition would be when a part of an organ is displaced or protrudes through the wall of the cavity containing it. And there’s lots of hernias throughout medicine. So, you know, like a hiatal hernia is where the stomach herniates into the chest, through the diaphragm. Patients may have heard, you know, people talking about a herniated disc in their back. So, that’s where, you know, the disc protrudes. But for this podcast, we’re focusing on hernias of the abdominal wall. And so that’s when there’s a hole within the fascia of the abdominal wall and something protrudes, whether that be intra-abdominal fat or intestine or some other organ. But the easiest way to think of a hernia is just a fancy word for a hole. And something’s going through that hole that shouldn’t be.

Host: Right. I think that’s the key point there, right? It really shouldn’t be going through. So when we think about the hernias that you deal with most often, how do they actually happen? Is, is it something we do to ourselves or something that just happens in the normal course of living our lives and all of a sudden you’ve got a hernia?

Dr. Schneider: So, I think for this podcast, we’ll focus on two specific types of the most common hernias that I work with. Hernias of the abdominal wall and hernias of the groin. And so in terms of how those happen, there are natural spots within the abdominal wall and the groin, that are naturally weaker just for how we develop.

And so one of the most common weak areas is in the groin, is called the inguinal canal. And that’s where all of our oblique muscles come together and form a small tunnel. And through that tunnel is where in men, for instance, the blood supply to the testicle travels. And so those blood vessels and the vas deferens that carries sperm have to try through that little tunnel. And so that’s a natural weak area that if that tunnel widens, then a hernia could form. Another natural weak area, is at the belly button or the umbilicus. You know, we all had the umbilical cord that supplied us oxygen, nutrients, blood when we were in our mother’s uterus. And so, when those muscles come together and form and that’s a natural, weak area at the belly button where you can develop a hernia. The other main reason they happen, are incisions. Unfortunately, a lot of hernias are from other surgeries. Anytime we make an incision on the fascia of the abdomen, it’s never going to be quite as strong as before that incision. And so those are the two main reasons people get hernias.

Host: And are some people more at risk for hernias? You say that it’s sort of just the natural part of the way, you know, bodies are designed or built or born, right? But are some of us just naturally more at risk?

Dr. Schneider: The biggest risk is a big incision. And so the best thing that people can do to lower their risk is, ask is there a way for this surgery that I’m having done, whatever it is, to be done with smaller incisions or a minimally invasive fashion. And then there’s a lot of other risks, you know, if you’re going to have an incision, what sort of risk factors do you have for wound healing? Obesity, smoking, diabetes, all of these will decrease someone’s ability to heal their wound and be more prone to a hernia. We know also that males are at way higher risk for developing an inguinal hernia compared to a female, again, because they have the blood supply and the vas deferens going through that inguinal canal to supply the testicle to where as a female would not.

Host: I feel like everyone’s had a hernia and knows what it feels like, but maybe not. So let’s talk about that. What does it feel like? How do we know when we have a hernia and when should we see a doctor?

Dr. Schneider: So, symptoms of hernia, the most common thing that many people see is a bulge. They’ll, you know, all of a sudden they may have had a flat scar at a prior incision, and now it’s kind of swollen or bulging out, particularly when they’re increasing their intra-abdominal pressure, maybe coughing, maybe exercising, lifting. And they may notice that bulge gets worse. Pain at the bulge or pain in the groin could be a symptom. And then there’s also a spectrum of symptoms, depending on what’s actually herniating. A lot of times we worry about if there’s intestine getting pushed through this hole, it could get pinched or kinked, and that could create an obstruction which would lead to nausea or vomiting and sometimes be a surgical emergency.

But again, the most common symptom would be a bulge. Back to your other question, when should you see a doctor? Always, any time that you are concerned that there’s a bulge, or you may have a hernia, I would recommend you get evaluated by a surgeon that practices hernia repair. Cause hernias are very complicated and we have to take into account the entire patient picture, what type of hernia it is, how big it is, how symptomatic they are, what are the other medical problems that a patient has?

And so it’s a very complex decision on whether a patient wants to move forward with a hernia repair. And that kind of requires some in-depth conversation between the patient and the doctor about everything going on, both medically and with the hernia itself.

Host: And when we think about hernia treatment, you mentioned robots earlier, and I just love to talk about robots anytime I can, because robots are undeniably cool. But how are you treating hernias? Are robots involved? What’s the course of action with the, again, as you said, when we started today, the most common types of hernias?

Dr. Schneider: In terms of treating hernias, sometimes patients don’t need surgery. Sometimes there’s too many other medical problems going on to justify the risk of surgery. Sometimes hernias are extremely small and are completely asymptomatic or they don’t cause any pain. There’s just a mild bulge and it may be not worth the repair. Again, why you should always see a surgeon and talk about the risk and benefits of repair.

In terms of repairing a hernia surgically, you know, in my practice we have specific goals regarding hernia repair. One is, fix the hole. So, I do everything I possibly can specifically with abdominal wall hernias to close the hole. And then, the goal is to reinforce that hole with mesh and then another secondary goal that I usually try to have with my surgeries is finding a safe plane or layer of the abdominal wall to hide that mesh in, so there’s good healing, low infection rate and low risk of complications from the mesh. And most of the time I am able to do this in a minimally invasive fashion, robotically. Robotic surgery allows us to use very small incisions to fix hernias and allows excellent visualization and 3D visualization with wristed instruments in order to be able to close those holes in a very careful particular fashion, so these hernias don’t come back. And then allows us to dissect within the layers of the abdomen to place the mesh within those layers so that you get a good strong repair.

Host: Yeah. You mentioned, trying to prevent the hernias from coming back. And that was actually gonna be my wrap-up question for you today was, you know, can they come back? It sounds like they can. Why do they come back? And is there anything we can do, you know, you’ve talked about what you’ll do to try to prevent that. Is there anything we can do to try to prevent hernias from coming in?

Dr. Schneider: Yeah. So the first thing is making sure that you have a solid plan with your surgeon about the surgical approach and whether or not to use a mesh. Mesh is very safe and honestly, probably the gold standard for most of the hernia repairs that I do. Mesh can significantly reduce the risk of recurrence up to even 70% compared to just a suture repair of some abdominal wall hernias.

And then, what the patient can do moving forward in preparing for their surgery is optimizing themselves for that repair; stopping smoking, losing weight, controlling their blood sugar. And then slowly increasing activity after the repair, based on their doctor’s instructions.

Host: Yeah, this has been really helpful today because I think hernias are really common. And obviously, you know, there are times when surgical intervention is indicated. There are things that we, you to maybe prevent them, but certainly to make sure that they don’t come back. So, really educational, great conversation today. Thanks, Dr. Schneider and you stay well.

Dr. Schneider: Thank you.

Host: For more information and other podcasts, just like this one, head on over to PrismaHealth.org. This has been Flourish, a podcast brought to you by Prisma Health. I’m Scott Webb. Stay well.