Dr. Matherne discusses the topic of hernias.
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What is a Hernia
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Learn more about Louis Matherne IV, MD
Louis D. Matherne IV, MD
Dr. Louis Matherne specializes in general surgery in Lutz, Florida. Dr. Matherne received his undergraduate degree in biomedical sciences from the University of South Alabama in Mobile, Alabama and then earned his Doctor of Medicine from Ross University School of Medicine in Dominica, West Indies. He continued his medical education by completing an internal medicine internship at New York Methodist Hospital in Brooklyn, New York and a general surgery residency at The Jewish Hospital in Cincinnati, Ohio. Dr. Matherne’s clinical interests include general surgery, with an emphasis on the use of robotics. He is a member of the American College of Surgeons. Dr. Matherne is affiliated with St. Joseph’s Hospital-North.Learn more about Louis Matherne IV, MD
Transcription:
What is a Hernia
Introduction: Here's another edition of the BayCare Health Systems podcast series, BayCare Health Chat with Melanie Cole.
Melanie Cole: Welcome to BayCare Health Chat. I'm Melanie Cole. And today we're discussing hernias. Joining me is Dr. Louis Matherne, he's a General Surgeon with BayCare. Dr. Matherne it's a pleasure to have you with us today. We hear this term hernia all the time, but I don't know that people really understand what it is. Tell us what is a hernia and what are the various types, because we also hear different names in front of the word hernia. So tell us about the different types and what does it mean to have a hernia?
Dr. Matherne: So in general, let me talk about a hernia. That's going to mean a bulge through the opening of the muscles of the abdominal wall. There are a lot of different types of hernias, and you may hear a couple of other types of hernias that actually aren't, or wouldn't fall in that category. A couple of those that you might hear would be a Hiado hernia, which is actually a bulging of the abdominal contents into the chest or an internal hernia, which happens on the inside of the abdomen. That can cause a bowel obstruction. Those are the two types that you might hear that are sort of outside of the scope of this discussion. But as far as abdominal wall, the major different types of those would be what's called a ventral hernia. That is a hernia, really it just means it's anywhere on the abdominal wall. There's also different types of ventral hernias, which we can get into a little bit later if you like. But some of the other types of abdominal wall hernias would be epigastric hernias, which is a hernia that is also ventral, but it's specifically on the midline of the abdomen above the umbilicus or the belly button. And then you also have an umbilical hernia, which is specifically right at the umbilicus. And then you have what is commonly referred to as a groin or inguinal hernia, which is in the region of the groin on either side.
Host: So as we're looking at these different types and the ones that you most commonly see, how would people know they have one? Are there symptoms? Can you see it feel it, does it hurt? Tell us how we would even know.
Dr. Matherne: Certainly the most common sign is simply a bulge in some area of your abdomen or your groin. Commonly, you'll notice that the bolts will go in and out with pressure. In other words, you might not see it when you wake up in the morning, but by the end of the day after you've been standing up all day, maybe it's there, or maybe you notice it when you're straining or lifting or doing something that causes increase in your abdominal pressure. Sometimes it's a bulge that's always there. Often people do have some discomfort or pain in this area. In rare cases, or in more serious cases, people can have severe pain. Notice some skin changes around that area, maybe some darkening of the skin, and have what's called obstipation other words, their bowels aren't really functioning much anymore. They might notice that they're not passing gas or not having bowel movements, maybe their abdomens getting distended, and they might be vomiting. And those last few things that I talked about are the more serious signs that are surgical emergencies.
Host: So are there certain risk factors to these? Do we know why people get hernias? What causes them, or if there's a certain population that gets them more than others.
Dr. Matherne: So, you know, a large portion of them are congenital and they can just increase over time. But we do see a higher percentage in people who have been operated on. In other words, just having an, any incision through your abdomen at any time as a risk factor for a hernia occurring there. You see them more often in the obese population and people in general, who have conditions that create more pressure intrabdomenly than normal. In other words, you might see them in smokers who have a chronic cough or people who have chronic constipation, not necessarily the may cause the hernia, but they can, and may certainly contribute to it becoming larger.
Host: So then you mentioned some of the more emergent complications, do they all have to be treated? Tell us about treatment options when you do a sort of a watch and wait, or when you decide, yes, we need to get right in there and fix this.
Dr. Matherne: So again, there's going to be a certain number of cases where you just say, Hey, we need to fix this immediately period. It's going to be a certain number of cases where we can say, Hey, it's a very safe to watch this indefinitely, unless something changes. And then there's a whole bunch of people who are in the middle. And that's why I think it's so important for people with a hernia to see a general surgeon, someone who is sort of the expert within the medical field on these, so that you can discuss that with your physician and know, okay, this is type of hernia, have these are the risks I'm facing because this specific type of hernia and the specific type of patient that I am. And that's why I think it's really important for anybody with a hernia to at least have that discussion with a surgeon. But try to answer that question maybe a little better. Certainly if you have any of the signs we talked about, there is going to be an urgent need to get the surgery. In other words, if the hernia is what we call strangulated, that's an indication for emergency surgery.
And what strangulation means is that there is some bowel that has become trapped within the hernia and that based on the symptoms that we're seeing and maybe lab values and how the patient's presenting, we have reason to believe that the blood supply to that bowel is compromised. Which means the longer you wait, the higher chance that operation is now not just going to be a repair of that hernia and taking down that bowel, but could also involve a resection of that bowel. Sort of the next step down from a strangulation is what's called an incarceration, which just means that that bowel is stuck there, but we don't any reason to believe that there's any loss of blood supply at this point. Those are ones that you can take a little more time to fix, but that in general, you would recommend fixing those because there is that risk for them to become strangulated or some risk of that. But again, that's something that you would sort of decide on a case by case basis, given the risk factors of the patient, the symptoms that they're having, how long it's been there, possibly the size of sort of the neck of the hernia, where it's at, etcetera.
And then there's a whole other population that you don't necessarily have to operate on just to fix the hernia. And that's really more of a symptom decision. In other words, is this bothering you? Is it affecting your day to day life? And if it is, then I usually recommend getting it repaired and that's really kind of up to the patient on how much it's affecting their life. And then there's another group that they notice it's there. It causes them really no symptoms at all. And then it's really just a question of, Hey, hernias do not get smaller and there's no fix for them other than surgery. And depending on the type or where it's at, there might be slightly different risk on whether or not that hernia, how likely it is to get bigger. And so you have that discussion with them. And sometimes patients say, you know what? I don't want to take the chance of it getting bigger and giving me problems on the route. I want to fix it where it's small and the surgery is going to be as least invasive as possible. And so you go ahead and fix those and some people say, Hey, you know what? I don't want to do anything about it because it's not bothering me. And at least you discuss the symptoms for them to look out for, or at least a little more educated on what it is and what to look for, and they know who to call and when to call, if things do change.
Host: Now, tell us about just some of the treatments because people have heard about mesh. And then they're wondering if it's safe, just give us a brief overview of when you do decide to do treatment, reinforce and encourage the listeners, the safety and efficacy of your treatments?
Dr. Matherne: In general, the standard of care. In other words, if physicians are often judged, you know, whether or not they are doing what is the accepted standard of care within their field and standard of care in general surgery for most hernia repairs is to use mesh. So if you don't use mess, you're not doing what is the accepted recommended guidelines for hernia repairs, from, you know, American college of surgeons and all of these different groups, for the most part. Obviously I've heard of these lawsuits and things like that, but most of those have involved different types of meshes that are placed in different places that we're not speaking about right now. The mesh is a significant improvement or decrease in the likelihood of recurrence. And that's why it's recommended that you use them. For the most part. There are certain instances where you, wouldn't one of them being a very small umbilical hernia.
And in other words, if it's less than about two centimeters, the recommendation is to not use mesh. Now, you may change that a bit. If your patient itself is at higher risk of a recurrence because of their particular risk factors, you may use the mesh in a 1.5 centimeter, but so a small umbilical hernia would be one where you wouldn't use mesh. And then in cases where there is a significant risk for wound infection, you either might not be able to use mesh because of the risk of that mesh getting infected. And the possibility you'd have to go in later and take that mesh out, and then close it again without a mesh. And then potentially set the patient up for another surgery down the road, or you would adjust the type of mesh that you would use. In other words, you would use a mesh that has been shown to be less, maybe more resistant to infection, then the permanent meshes that we often use.
Host: So interesting. What a great topic, wrap it up for us, Dr. Matherne with your best advice on hernia and treatment options available at BayCare. And when you feel it's important that listeners know when to see a doctor.
Dr. Matherne: So I'll start over the last part. I think it's important for patients to see a general surgeon, if they have a hernia, any type of hernia period. Have that conversation and be educated on what to look for, if things are worsening. And even if you're not going to have surgery, I think that's just a good conversation to have and good information to have. One of the reasons I feel so strongly about that is just the number of patients that we see in the emergency room, who come in with an incarcerated hernia, or maybe even a strangulated hernia, and we're taking them emergently and they say, yeah, I've known about this hernia for years. One of my doctors said, you know, don't worry about it. And I've never seen a surgeon about it. Maybe that patient would have made a different decision. Had they had all the information and maybe they wouldn't be going to an emergency surgery with the potential for needing their bowel resected. And they would have had a, you know, a nice outpatient procedure a year ago. You do see that a lot. In line with that is that often the options that you have for fixing the hernia are a little bit better if you can do them as an outpatient or as an elective procedure.
In other words, when it's gotten to the emergent procedure point, a lot of times it's not an option to then do a minimally invasive meaning, a laparoscopic or a robotic procedure. And that's something that we do here at BayCare at Saint Joe's North. And I think that probably most of our hospitals, but we do use laparoscopy and robotics to do probably I'd say a majority of the elective hernia repairs that we do. And the benefits that we see there is that patients usually have significantly less pain postoperatively. They can sort of return to their normal life a bit sooner than if they have the larger incision and often they don't even need to stay in the hospital at all. Versus if you were doing the same repair, another words repairing the same hernia, but doing it in an open way to potentially require two to four days in the hospital. Whereas you see patients who you do it possibly robotically, and they're going home straight from PACU (post-anesthesia care unit).
Host: Wow. That's amazing the technology today. And thank you so much, Dr. Matherne for coming on and sharing your incredible expertise with us today. And that concludes this episode of BayCare Health Chat. Please visit our website at baycare.org for more information, and to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other BayCare podcasts for more health tips, such as these, please follow us on your social channels. I'm Melanie Cole.
What is a Hernia
Introduction: Here's another edition of the BayCare Health Systems podcast series, BayCare Health Chat with Melanie Cole.
Melanie Cole: Welcome to BayCare Health Chat. I'm Melanie Cole. And today we're discussing hernias. Joining me is Dr. Louis Matherne, he's a General Surgeon with BayCare. Dr. Matherne it's a pleasure to have you with us today. We hear this term hernia all the time, but I don't know that people really understand what it is. Tell us what is a hernia and what are the various types, because we also hear different names in front of the word hernia. So tell us about the different types and what does it mean to have a hernia?
Dr. Matherne: So in general, let me talk about a hernia. That's going to mean a bulge through the opening of the muscles of the abdominal wall. There are a lot of different types of hernias, and you may hear a couple of other types of hernias that actually aren't, or wouldn't fall in that category. A couple of those that you might hear would be a Hiado hernia, which is actually a bulging of the abdominal contents into the chest or an internal hernia, which happens on the inside of the abdomen. That can cause a bowel obstruction. Those are the two types that you might hear that are sort of outside of the scope of this discussion. But as far as abdominal wall, the major different types of those would be what's called a ventral hernia. That is a hernia, really it just means it's anywhere on the abdominal wall. There's also different types of ventral hernias, which we can get into a little bit later if you like. But some of the other types of abdominal wall hernias would be epigastric hernias, which is a hernia that is also ventral, but it's specifically on the midline of the abdomen above the umbilicus or the belly button. And then you also have an umbilical hernia, which is specifically right at the umbilicus. And then you have what is commonly referred to as a groin or inguinal hernia, which is in the region of the groin on either side.
Host: So as we're looking at these different types and the ones that you most commonly see, how would people know they have one? Are there symptoms? Can you see it feel it, does it hurt? Tell us how we would even know.
Dr. Matherne: Certainly the most common sign is simply a bulge in some area of your abdomen or your groin. Commonly, you'll notice that the bolts will go in and out with pressure. In other words, you might not see it when you wake up in the morning, but by the end of the day after you've been standing up all day, maybe it's there, or maybe you notice it when you're straining or lifting or doing something that causes increase in your abdominal pressure. Sometimes it's a bulge that's always there. Often people do have some discomfort or pain in this area. In rare cases, or in more serious cases, people can have severe pain. Notice some skin changes around that area, maybe some darkening of the skin, and have what's called obstipation other words, their bowels aren't really functioning much anymore. They might notice that they're not passing gas or not having bowel movements, maybe their abdomens getting distended, and they might be vomiting. And those last few things that I talked about are the more serious signs that are surgical emergencies.
Host: So are there certain risk factors to these? Do we know why people get hernias? What causes them, or if there's a certain population that gets them more than others.
Dr. Matherne: So, you know, a large portion of them are congenital and they can just increase over time. But we do see a higher percentage in people who have been operated on. In other words, just having an, any incision through your abdomen at any time as a risk factor for a hernia occurring there. You see them more often in the obese population and people in general, who have conditions that create more pressure intrabdomenly than normal. In other words, you might see them in smokers who have a chronic cough or people who have chronic constipation, not necessarily the may cause the hernia, but they can, and may certainly contribute to it becoming larger.
Host: So then you mentioned some of the more emergent complications, do they all have to be treated? Tell us about treatment options when you do a sort of a watch and wait, or when you decide, yes, we need to get right in there and fix this.
Dr. Matherne: So again, there's going to be a certain number of cases where you just say, Hey, we need to fix this immediately period. It's going to be a certain number of cases where we can say, Hey, it's a very safe to watch this indefinitely, unless something changes. And then there's a whole bunch of people who are in the middle. And that's why I think it's so important for people with a hernia to see a general surgeon, someone who is sort of the expert within the medical field on these, so that you can discuss that with your physician and know, okay, this is type of hernia, have these are the risks I'm facing because this specific type of hernia and the specific type of patient that I am. And that's why I think it's really important for anybody with a hernia to at least have that discussion with a surgeon. But try to answer that question maybe a little better. Certainly if you have any of the signs we talked about, there is going to be an urgent need to get the surgery. In other words, if the hernia is what we call strangulated, that's an indication for emergency surgery.
And what strangulation means is that there is some bowel that has become trapped within the hernia and that based on the symptoms that we're seeing and maybe lab values and how the patient's presenting, we have reason to believe that the blood supply to that bowel is compromised. Which means the longer you wait, the higher chance that operation is now not just going to be a repair of that hernia and taking down that bowel, but could also involve a resection of that bowel. Sort of the next step down from a strangulation is what's called an incarceration, which just means that that bowel is stuck there, but we don't any reason to believe that there's any loss of blood supply at this point. Those are ones that you can take a little more time to fix, but that in general, you would recommend fixing those because there is that risk for them to become strangulated or some risk of that. But again, that's something that you would sort of decide on a case by case basis, given the risk factors of the patient, the symptoms that they're having, how long it's been there, possibly the size of sort of the neck of the hernia, where it's at, etcetera.
And then there's a whole other population that you don't necessarily have to operate on just to fix the hernia. And that's really more of a symptom decision. In other words, is this bothering you? Is it affecting your day to day life? And if it is, then I usually recommend getting it repaired and that's really kind of up to the patient on how much it's affecting their life. And then there's another group that they notice it's there. It causes them really no symptoms at all. And then it's really just a question of, Hey, hernias do not get smaller and there's no fix for them other than surgery. And depending on the type or where it's at, there might be slightly different risk on whether or not that hernia, how likely it is to get bigger. And so you have that discussion with them. And sometimes patients say, you know what? I don't want to take the chance of it getting bigger and giving me problems on the route. I want to fix it where it's small and the surgery is going to be as least invasive as possible. And so you go ahead and fix those and some people say, Hey, you know what? I don't want to do anything about it because it's not bothering me. And at least you discuss the symptoms for them to look out for, or at least a little more educated on what it is and what to look for, and they know who to call and when to call, if things do change.
Host: Now, tell us about just some of the treatments because people have heard about mesh. And then they're wondering if it's safe, just give us a brief overview of when you do decide to do treatment, reinforce and encourage the listeners, the safety and efficacy of your treatments?
Dr. Matherne: In general, the standard of care. In other words, if physicians are often judged, you know, whether or not they are doing what is the accepted standard of care within their field and standard of care in general surgery for most hernia repairs is to use mesh. So if you don't use mess, you're not doing what is the accepted recommended guidelines for hernia repairs, from, you know, American college of surgeons and all of these different groups, for the most part. Obviously I've heard of these lawsuits and things like that, but most of those have involved different types of meshes that are placed in different places that we're not speaking about right now. The mesh is a significant improvement or decrease in the likelihood of recurrence. And that's why it's recommended that you use them. For the most part. There are certain instances where you, wouldn't one of them being a very small umbilical hernia.
And in other words, if it's less than about two centimeters, the recommendation is to not use mesh. Now, you may change that a bit. If your patient itself is at higher risk of a recurrence because of their particular risk factors, you may use the mesh in a 1.5 centimeter, but so a small umbilical hernia would be one where you wouldn't use mesh. And then in cases where there is a significant risk for wound infection, you either might not be able to use mesh because of the risk of that mesh getting infected. And the possibility you'd have to go in later and take that mesh out, and then close it again without a mesh. And then potentially set the patient up for another surgery down the road, or you would adjust the type of mesh that you would use. In other words, you would use a mesh that has been shown to be less, maybe more resistant to infection, then the permanent meshes that we often use.
Host: So interesting. What a great topic, wrap it up for us, Dr. Matherne with your best advice on hernia and treatment options available at BayCare. And when you feel it's important that listeners know when to see a doctor.
Dr. Matherne: So I'll start over the last part. I think it's important for patients to see a general surgeon, if they have a hernia, any type of hernia period. Have that conversation and be educated on what to look for, if things are worsening. And even if you're not going to have surgery, I think that's just a good conversation to have and good information to have. One of the reasons I feel so strongly about that is just the number of patients that we see in the emergency room, who come in with an incarcerated hernia, or maybe even a strangulated hernia, and we're taking them emergently and they say, yeah, I've known about this hernia for years. One of my doctors said, you know, don't worry about it. And I've never seen a surgeon about it. Maybe that patient would have made a different decision. Had they had all the information and maybe they wouldn't be going to an emergency surgery with the potential for needing their bowel resected. And they would have had a, you know, a nice outpatient procedure a year ago. You do see that a lot. In line with that is that often the options that you have for fixing the hernia are a little bit better if you can do them as an outpatient or as an elective procedure.
In other words, when it's gotten to the emergent procedure point, a lot of times it's not an option to then do a minimally invasive meaning, a laparoscopic or a robotic procedure. And that's something that we do here at BayCare at Saint Joe's North. And I think that probably most of our hospitals, but we do use laparoscopy and robotics to do probably I'd say a majority of the elective hernia repairs that we do. And the benefits that we see there is that patients usually have significantly less pain postoperatively. They can sort of return to their normal life a bit sooner than if they have the larger incision and often they don't even need to stay in the hospital at all. Versus if you were doing the same repair, another words repairing the same hernia, but doing it in an open way to potentially require two to four days in the hospital. Whereas you see patients who you do it possibly robotically, and they're going home straight from PACU (post-anesthesia care unit).
Host: Wow. That's amazing the technology today. And thank you so much, Dr. Matherne for coming on and sharing your incredible expertise with us today. And that concludes this episode of BayCare Health Chat. Please visit our website at baycare.org for more information, and to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other BayCare podcasts for more health tips, such as these, please follow us on your social channels. I'm Melanie Cole.