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Scott Webb (Host): Hernias are fairly common and highly treatable, but many of us tend to put off diagnosis and treatment, and sometimes that could lead to more significant health complications. And joining me today to tell us about hernia causes and treatment options, including the minimally invasive DaVinci robotic system is Dr. Igor Wanko Mboumi. He's a Board Certified Surgeon with the Franciscan Physician Network. This is the Franciscan Health Doc Pod. I'm Scott Webb. So doctor, thank you so much for your time today. We're talking about hernias. What is a hernia, exactly? And what are the most common types of hernias?

Igor Mboumi, MD (Guest): A hernia is really a defect of the abdominal wall. A defect presents usually as in simplest layman term, I'd say it is usually a hole, if you would think of it as a hole in the abdominal wall. So, if you had a hole in your wall at home. The difference between a what makes a hernia more of a particular thing to fix is the fact that our abdominal wall is used as a defense mechanism to protect our organs and our intestines and everything that is inside within the body. So, when you have a defect in the abdominal wall, sometimes you get things that protrude through the abdominal wall and that protrusion through a defect in your abdominal wall is essentially a hernia.

Host: And doctor, what are the most common types of hernias?

Dr. Mboumi:  I'd say the umbilical hernia, I would say is most common, one of the most common, because it's, a lot of times, just congenital. Patients have it when they're kids. And sometimes they people or patients develop it as they get older. As you possibly gain a little weight, there just would just wear and tear. And depending on what kind of vocation you have. The same thing with inguinal hernia, a body is prone to get inguinal hernias and a lot of people will just develop it over time from just exertion or just genetics and just life.

A third would be incisional hernia. So, anyone who's had a prior surgery anytime you do surgery, the abdominal wall heals at about 80% of initial strength. Every time after that, it heals at 80% still, but it's 80% of the original. So, it does get strong into that 80% of what the original prior to surgery. But anytime you have an incision, you're at risk of eventually getting a hernia or just a weakness in that area that was priorly, previously in ised. Other, in terms of to go back to number four, would be an epigastric or ventral hernia. That's when it's still abdominal wall, but not at the umbilicus. That usually can happen before the chest begins.

Another common type is femoral hernia that happens again also in the groin region, but it's usually underneath the region where the inguinal hernia happens. It is more common in women, especially as they get older. Again, usually it's genetics, or just bad luck. There's no known risk factor for femoral necessarily.

Host: Yeah. And it seems like the one that I hear about the most and you haven't mentioned yet is a hiatal hernia. So, how does that differ from the others?

Igor Mboumi, MD (Guest): Hiatal hernia is a very common hernia. The only difference between that and the other hernias that I mentioned is that it is not an abdominal wall hernia. A hiatal hernia is a hernia of the diaphragm. Just like I mentioned that the abdominal wall is the initial protection that protects your organs. The diaphragm serves as a muscle to help you breathe, but also it serves as a protection or the separation between the chest and the abdomen.

There's one organ, the esophagus that communicates with the abdomen that becomes the stomach as you go below the diaphragm. So, a hiatal hernia is when things that are or the stomach itself or the end part of the esophagus kind of protrudes through into the chest. So, patients have stomach parts within the chest cavity. And that's more of a hiatal hernia. You wouldn't see that necessarily on physical exam or you wouldn't feel a protrusion at all. Usually this will be diagnosed by patients who have bad heartburn or patients who have indigestion or difficulty swallowing and such things. It's just different in how we approach it. But it is essentially a hernia, but it's more of an internal hernia versus a hernia that's on the abdominal wall itself.

Host: So, what are the symptoms? How do we know as you say, you know, some are diagnosed differently than others, but generally speaking, what are the symptoms? What should we be on the lookout for?

Dr. Mboumi: Some of the most obvious symptoms would be pain. Some patients have what we call subclinical hernia, meaning that you may have an incision somewhere, or you just may have some pain around your groin, unexplained. And when you look and do an exam on yourself, for example, you may not notice a hernia, but sometimes it takes a little bit more of a trained eye to diagnose it and then to recognize it. But most commonly patients will see a protrusion, a bulge or something either at an area of prior incision or at the umbilicus or around the groin or around above the umbilicus. Or at any kind of prior incision anywhere on your body on the abdominal wall. So, pain is one. Protrusion is one. Sometimes things protrude through, and then they're not able to go back in and that causes a significant amount of pain also. And sometimes patients in a more extreme cases can have a bowel obstruction, meaning that sometimes the bowel itself can protrude through the defect or the hernia, and that can cause a blockage. And that usually presents with not being able to pass gas and feeling bloated and not having bowel movements that that is the ultimate thing that we try to prevent by fixing these hernias. To basically fix the defect and fix the hernia prior to a patient manifesting with an obstruction, meaning, the hernia bowel content protruding through the hernia and causing it to be incarcerated or to be stuck within the abdominal wall, or within the groin or within the any other region of the body.

Host: So let's talk about the surgical options. I know, I want to hear about this. I'm excited to hear about this. The DaVinci surgery. Tell us about the DaVinci surgery. Why is minimally invasive, robotic surgery becoming maybe more the norm? What are the advantages, disadvantages and so on?

Dr. Mboumi: That's actually, one of my passions is, minimally invasive robotic surgery and one of the things that has changed over the years is the way in which we fix these hernias. I've taken care of a lot of patients, different ages. One, one good example was to tell you about patients I've had who she was in her eighties. Of course, I'll try to stay away from details, but she was in her eighties and had a pretty large hernia. And she'd been, she'd had multiple co-morbidities and been through many surgeries in the past. She had seen prior other physicians who told her that it would be too high risk for her to undergo surgery, to fix the hernia because it's about 12 centimeters by 8 centimeters.

And given the technology that we have now, per se the DaVinci robot, more, as opposed to most physicians having to do it with a big open decision down the midline, which would put an older patient at risk of high risk of wound infection, and the pain from that incision can also have other morbidities like difficulty breathing and put them at risk for pneumonia. I was able to do her surgery with six small incisions, tiny half a millimeter to a millimeter incisions on her side. I was able to completely fix the hernia and bring it back together. And she was able to leave the hospital in three days, she was walking the next day. The only thing she complained about was her eyes, because she thinks she had some eyes that were a little red from irritation, from anesthesia or something.

And that's basically unheard of for it to happen, that kind of surgery for that kind of defect and to be able to get up the next day and walk at her age. I mean, I think that speaks volumes to what the robot, the advantage that the robot really brings. It's the ability to do things that would in the past be maximally invasive and turn them into minimally invasive procedures where patients are having less pain or having less difficulty ambulating the day after and they're back to their regular day activity.

Sometimes I'm so amazed I get in to operate on patients who have pain for years and a hernia that they've been dealing with and trying to cope with; I operate on them, within the next day, they're up and they're asking me if they can go home. Versus, trying to stay in the hospital for three, four days just to control their pain and I've done significant follow-up on these patients. And so far, I've had really good results. I've yet to see a recurrence. I'm not saying that I won't ever see one, but I've had been very happy and satisfied. The patients have been very happy and satisfied with the results.

Host: When we talk about DaVinci versus laparoscopic surgery, what are the differences? Are there still any advantages to laparoscopy? When might that be preferred over DaVinci? Maybe you can take us through that.

Dr. Mboumi: Yeah. I mean, there's been a lot of data, a lot of papers that have looked at the advantages versus disadvantages. It depends on which hernia you're referring to, which we want to focus on. So, if we talk about inguinal hernias, if we're comparing, we're talking about a surgeon who's used to doing things open and open procedures, for example, then the laparoscope becomes a great benefit because if they can convert to a laparoscope or convert to a robotic procedure, then you minimize the incision and the pain benefits have been shown and they're also of great help. One other advantage is that for example, people who have hernias on both sides, inguinal hernias on both sides, someone who can do the surgery minimally invasively can usually do both sides at the same time, versus if you were doing open surgery, most physicians will opt to do one side at a time.

So, that's two times where you have to be put under anesthesia, a longer time of recovery and a longer time being away from work and such. And you compare a laparoscopic to robotics overall, I think that results are pretty similar. They're both pretty good surgeries. The only difference between the two is that with the robot, what you can do with a robot in terms of the huge abdominal wall reconstruction for bigger hernias, the ergonomics laparoscopically, would not be possible. It becomes almost impossible to do that laparoscopically. The patients would most likely need an open surgery. So, that's the advantage that the robot brings. But for other more simple hernias, I, myself can do laparoscopic surgery and I often opt to do laparoscopic surgery because it's sometimes easier for patients also because you get them in and out of the hospital, sometimes easier for hernias that are not that big.

And it can be done at the outpatient surgery center and sometimes it can take less time to do. But, with that said, for most of these hernia repairs, the data has mostly shown that a lot of the results are similar. The things that you do has your bet on, or the things that can, you can sacrifice is the higher wound infection rate with open surgery versus a minimally invasive approach like laparoscopic or robotics. So, overall I think they're all good techniques and I personally pride myself in being able to offer all three to my patients. And, I don't think there's necessarily a right or wrong because an open surgeon who's been doing it for 30 years and who's great at it has great results can be a good benefit.

But being able to offer patients the open technique when it's needed versus a laparoscopic technique versus a robotic technique for all kinds of hernias and all different kinds of hernias. I think I personally pride myself on that and I have partners here at   Franciscan Health, who do robotics also, and are very apt and adept in doing open repairs as well as laparoscopic repairs and robotic repairs. I think it would be a great place for patients who want that option and have an interest in seeing what the best approach is.

Host: And as we get close to wrapping up here, Doctor, anything else you want people to know about hernias, diagnosing, the common symptoms, treatment? What else do we need people to know? What's the takeaway today on hernias?

Dr. Mboumi: The key thing to note is that the technology now has advanced to a point where sometimes living with it is a lot worse than undergoing a procedure and healing from that procedure and never having to deal with it again. Don't be afraid to ask for a referral from your primary care doctor to see a surgeon. Of course, we'll be glad and happy to see you here at St. Francis or anywhere else within the city. I think that it's important to get these things taken care of before they become bigger. And before they end up with complications, like we mentioned, like a bowel obstruction or anything like that.

Host: Great information today, Doctor. Love your expertise and your passion for the DaVinci robot, especially. Uh, thank you so much and you stay well.

Dr. Mboumi: Thank you.

Host: Franciscan Health has the best surgical team and the latest technologies. At Franciscan Health, you can be confident about your choice of minimally invasive surgery. Franciscan Health offers several locations for minimally invasive surgical options for hernia repair. For more information, go to Franciscandocs.org and search general surgery. And we hope you found this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Thanks for listening.