Transcription:
Hernias: What They Are And How They're Treated

Maggie McKay: Have you ever lifted something really heavy and somebody with you says, "Lift with your legs, not your back. You'll get a hernia." Would you even know if you had a hernia?

This is Kraus HealthCast. I'm your host, Maggie McKay, and here to tell us more about what hernias are and how they're treated is Dr. Benjamin Satta wits, a board certified general surgeon at Crouse medical practice surgical services thank you so much for joining us today.

Dr. Benjamin Sadowitz: Thank you so much for having me. I appreciate it.

Maggie McKay: For starters, what is a hernia and why do they even form?

Dr. Benjamin Sadowitz: Well, that's a very good question. So in people who have never had surgery before, we typically see hernias at the weak areas of the abdominal wall. And those areas would be the groin areas and the belly button area. Now, for people who have undergone previous abdominal surgery, previous incisions can also be weak areas in the abdominal wall that are prone to hernia. So those are typically where and when we see hernias in our patients.

Maggie McKay: And so is there a certain group of people that you see hernias in more often like workers who have to lift heavy things for example?

Dr. Benjamin Sadowitz: So that's another great question. We do tend to see hernias in people who have heavy lifting jobs that puts a lot of pressure on the abdominal wall. And if they have one of those weak areas we talked about that's exploited, they can certainly develop hernia there, and heavy lifting contributes. You know, really anything that puts pressure on the abdominal wall, even like playing something like the trumpet can generate a tremendous amount of pressure on the abdominal wall.

But certainly, we do see a fair share of people who have heavy lifting jobs who will come in with hernia. And it's certainly not uncommon to have an incident where there's a heavy lift or a pull or a push and people all of a sudden feel pain or a pop or something that would indicate to them they have a hernia in the area. So actually, that is a pretty fairly common story.

Maggie McKay: I've heard they're very painful, and especially when you don't know what you're suffering from. Is that accurate in all cases?

Dr. Benjamin Sadowitz: Not in all cases. Some people have hernias their whole lives that never bothered them. They never get bigger than ever become uncomfortable. So we see a fair number of those through the office and, depending on how small and asymptomatic they are, we don't need to fix them. But the flip side of that is we can certainly have people who come in with very painful hernias that are really inhibiting their ability to do their activities of daily living or their job that really need to be fixed.

And I think the other piece of that is for people with symptomatic hernias, the risk your running is stuff can get stuck in them, because a hernia is actually a hole in the abdominal wall. There's all these layers that make up the abdominal wall. And the most important layer in terms of hernia is the connective tissue layer. And if that layer has been disrupted and there's a hole there, stuff can push through that hole and the stuff inside your belly that's typically pushing through that hole can be your intestines or the fatty drape that covers the intestines. Now, if that fatty drape pushes in there and gets stuck, that's not as urgent as if a piece of intestine gets trapped in there.

So for all our hernia patients, we tell them if they're going to try to manage their hernia conservatively, you need to watch out for the signs of your hernia getting stuck or what we call incarcerated. So, there's certainly a broad spectrum of, you know, symptomatology with hernia from completely asymptomatic to very symptomatic. And generally, these ones that are symptomatic and affecting quality of life, those are certainly ones that we're going to fix.

Maggie McKay: What are the methods of hernia repair?

Dr. Benjamin Sadowitz: So the traditional way to fix the hernia was to make a large incision over the area of the hernia and to close that sort of hole or defect. And then you reinforce it with a piece of mesh. Nowadays, we tend to try to do these in a minimally invasive fashion, so much smaller incisions. The principles still stay the same. We still try to close the hernia defect or the hole that we see and then reinforce it with a piece of mesh. I think this is what sort of scares people the most because mesh commercials are typically, you know, at least in this country, lawyer-type commercials where people are telling you mesh is going to be bad for you. But the reason we use it is to reinforce that area and to give it some extra strength. And without using mesh, you're at a higher risk of recurrent hernia. So, certainly mesh technology has changed over time. We use much different meshes than we did even 10 years ago.

And it's all about minimizing risks. So we want to minimize your risk of recurrent hernia. And using a piece of mesh will help us to do that. But certainly, we try to do the bulk of these hernias in a minimally invasive fashion so that the recovery is faster. There's less pain. People are back to their daily activities, you know, quicker, back to their jobs quicker. So certainly, the way we fix these has changed a lot through time.

Maggie McKay: To alleviate the fears of possible patients, how has mesh changed from like you said 10 years ago until today? What is it made of?

Dr. Benjamin Sadowitz: So good question. So nowadays, we even have meshes that dissolves away over time, and we also have some meshes that are made of biologic material that tend to not be so adhesive forming. Some of the past meshes had a real problem with adhesions and they didn't incorporate well into the abdominal wall.

The bulk of the meshes we use nowadays are meshes that are very porous, so your body's own tissues grow into it and use it almost like a scaffold. And a lot of these meshes are made of polypropylene, which is the same material as much of our suture material. So the idea that your body is going to reject it or that you won't tolerate it, I can't say I've ever seen that with any patients. Certainly, there's always risk of things like adhesion-formation. But, you know, a lot of the meshes now how these anti-adhesive coatings that are put on them to help prevent that as well.

So the technology has changed dramatically from what we use even 10, 20 years ago. Some of those older meshes had none of this new technology and were, you know, sort of thick pieces of Gore-Tex that you could sew into the abdominal wall, but they didn't incorporate well, they didn't have some of the features that our newer meshes have in terms of anti-adhesive coating. So the technology has come a long way.

Maggie McKay: Well, that sounds very reassuring for people who, like you said, those commercials just scare the wits out of you, you know, when you hear anything about mesh.

Dr. Benjamin Sadowitz: Yeah. Honestly, we have a lot of questions about that and I always tell people, "Listen, you have to accept a little bit of mesh risk." It's not totally zero risk. Anytime you have an implant, be it an orthopedic one or general surgical one, there is always risk of things like infection or adhesion formation. But I think that risk is small, especially in healthy people. And you get this huge drop in recurrent hernia risk by using it. So there is some risks trade-off there. The mesh is not completely benign, but without it, for many people, you're almost guaranteed a recurrent hernia and then another operation to try to fix it.

So we try to give people as much information as possible to make a well-informed decision as to how their hernia will be fixed. But I will tell you there's very few surgeons nowadays who will fix your hernias without mesh. And the recurrence rates unfortunately are very high.

Maggie McKay: Is there something called a double hernia? And if so, what is that?

Dr. Benjamin Sadowitz: So usually when people say they have a double hernia, they're talking about the groin area. So the groin area is naturally weak. There's a weakness there that is, especially for guys, sometimes very easy to develop hernias. And most of the people who come to us with a so-called double hernia have a hernia in each side of the groin.

The nice thing about the way we fix these now, we typically, at least I typically fix them in a minimally invasive fashion. So it's almost like you're getting two hernia repairs for the price of one. We don't have to make extra incisions to fix the second one. That's generally tolerated very well. And then it being done in a minimally invasive fashion with the newer meshes we have tends to be much less painful. People tend to get back to work quicker and use less pain medicine. And, you know, when I first started practice, I did a lot of those groin-type hernias in an open fashion. And I don't think I really do any of them that way anymore because the patient results are so good and they tend to just do so much better in terms of pain and return to activity afterwards.

Maggie McKay: That's wonderful. Usually, you hear about men having hernias, but can women get them as well?

Dr. Benjamin Sadowitz: Absolutely. So the groin hernias, I think, are a little bit more common in men, just because of the sort of embryologic changes that happen during development. The testicles have to travel from inside the abdominal cavity down the inguinal canal and into the scrotum. And that pathway that's left behind has to close down, but it never gets to the rest of the strength of your abdominal wall. Women don't really deal with that. They have the round ligament of the uterus there in the groin canal, so there's not as much of a weakness. So certainly, we tend to see, I think, more groin hernias in guys because of that. But, you know, for women, especially women who've been pregnant, their paraumbilical area tends to get very weak. So I think we tend to see a lot of these belly button hernias, especially in women who've had multiple children because their abdominal wall gets stretched out during pregnancy and they tend to be very sort of hernia-prone some women.

So, I wouldn't say it's one over the other. I would say in the United States, for example, honestly, our number one cause of hernia is previous surgery. So if you've had a previous operation, that's really the number one cause of hernia in this country. Certainly, we see our fair share of, you know, people who haven't had surgery who have belly button hernias and groin hernias, but the bulk of the hernias in this country actually are from previous surgery.

Maggie McKay: So what are the patient factors that affect hernia recurrence? Like let's say you've had surgery, you've had a hernia and you have to have surgery again. Is there a good likelihood that you're going to get another hernia?

Dr. Benjamin Sadowitz: So that's a good question. So there are certain high risk procedures for hernia, like some of the open vascular and open colorectal procedures tend to be high risk for hernia. So there's some procedure-related risk. But also there's a huge amount of sort of patient factor risks that we talked to patients a lot about before surgery. And I think the three biggest things for patients are smoking, diabetes and obesity. Those factors, especially if they're in combination really increase your risk of both recurrent hernia and then complications, you know, preoperatively and postoperatively. So if we see patients for hernia and they're smoking, we make them quit. Smoking is really a deal breaker for abdominal wall hernias in particular, not so much for the groin hernias, but smoking is a well-known risk factor that really ruins hernia repairs. If patients are diabetic, we have them get their diabetes well controlled. And then if there's a factor of morbid obesity, we really try to get them to lose weight before surgery. But that combination of factors or even one of those factors, if it's severe, really affects hernia repair. If you have an abdominal surgery, it can promote hernia formation. We really try to get those three patient factors controlled before surgery.

Maggie McKay: Wow. I had no idea about some of those. That's good to know. Well, Dr. Sadowitz, thank you so much for sharing your knowledge with us today. It was so educational. I learned a lot. And to learn more or to schedule an appointment with Dr. Sadowitz, visit crouse.org/benjaminsadowitz or call 315-470-7364. Thank you for tuning into Crouse HealthCast. I'm Maggie McKay. Be well.