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Scott Webb (Host): If you've ever had a hernia, you know that they can be painful and can affect our quality of life. The good thing is that hernias are highly treatable and we don't have to live with them. And joining me today is Dr. Igor Wanko Mboumi. He's a Board Certified Surgeon with Franciscan Physician Network, and he's going to take us through the different types and causes of hernias and discuss our surgical options, including the DaVinci Robotic System.

This is the Franciscan Health Doc Pod. I'm Scott Webb. So, Doctor it's so great to be back on with you again, and we're talking about hernias today and the types of surgeries, but before we get there, what are the most common types of hernias?

Igor Wanko Mboumi, MD (Guest): The ones that we see most commonly are belly button hernias, which we call umbilical hernias, groin hernias which we call inguinal hernias. There is incisional hernias which are hernias that you get from having any prior surgery or an incision or such, other hernias that you see that are common hernias that are usually around the belly button but above it. These are ventral hernias, or epigastric hernias, called epigastric cause they're a little bit higher in the abdominal wall. This is in regards to all abdominal hernias. There's some other ones that are a little obscure, but are probably not the ones that are going to be more common.

Host: And generally speaking, what are the causes of hernias?

Dr. Mboumi: Causes of hernias, some of it is congenital. In terms of congenital there's some areas in the body, which things go through the abdominal wall. If you notice the areas that I mentioned in terms of the umbilicus and the groin, usually, men have spermatic cords that goes through and basically connect the testicles to the penis. Those I'll call that the spermatic cords and those go through the abdominal wall and create a weakness around that. As you go up onto the abdomen a little further, the umbilical cord that we're born with that then becomes the belly button also is something going through the abdominal wall. So, that causes weakness.

And any time you have anything going through the abdominal wall, that is basically congenital weakness over time that is predisposed to getting hernias. But people who actually do get hernias other than just the fact that you had something that was kind of developed to development and through birth, there's genetics, some people are more prone to have weaker tissues and different reasons to get hernias.

There are also things you do, like having prior surgeries and the number one reasons, other things are occupation. So, if you do a lot of weight lifting or if you do a lot of physical work, that could make you prone to getting hernias or even younger people when they exercise, they tend to have some hernias. One hernia that I didn't mention that is very common is also a parastomal hernia, which is a hernia in patients who have an ostomy bag. This is kind of hernia that I tend to see a lot me at my office.

Host: Yeah. And I've had a hernia before and it was kind of this, a dull nagging sensation I wouldn't call it pain, necessarily, it just was this kind of like I could just feel this sorta nagging thing there. And I guess I'm wondering for most people, what are the symptoms of hernia? Is it always pain or can it be that kind of dull nagging thing as well?

Dr. Mboumi: Very good question. I think the most common symptom is pain, if you have symptoms. But a lot of hernias believe it or not end up not being very symptomatic where you could see a bulge and it may be over incision or it may be around the umbilicus or in the groin. And it may also be getting bigger and bigger yet, and it's not causing any pain. But when patients do have symptoms, pain is kind of one of the first ones to present. And the reason why patients have pain is usually because something is getting stuck within the hernia and being reduced back in the abdomen. The worst case scenario with hernia in terms of symptoms is having a piece of bowel stuck within the hernia.

If you think about a hernia is really just a defect in the on abdominal wall. Is like a hole. So, anything can kind of go through the hernia. So, anytime somebody has a defect with time, things can kind of go in the hernia or the hernia can keep getting bigger. We generally like to intervene and take care of patients when they have symptoms or when they don't have symptoms, because you want to prevent the worst from happening. Meaning bowel getting stuck in there. Cause it does get stuck in there, it can be without oxygen. And then you may end up having to have a bowel resection and need to be in the hospital for awhile. So, we try to prevent that as much as we can.

Host: Yeah, and it does seem that hernias are common, but also highly treatable, but of course we have to reach out and seek that treatment. And so, when we talk about hernia surgeries, you know now it can be done in a multitude of ways. There's minimally invasive robotic surgery, laparoscopic surgery, as well as, you know, traditional open surgery. So, let's talk about the DaVinci surgery and some of the benefits.

Dr. Mboumi: I'm glad you brought that up. One of the things that I trained to do when I specialized in my Fellowship work to do some robotic hernia repairs. The reason why I'm a big proponent of the robotic hernia repairs is because you can do it minimally invasively. A good example was a patient of mine that I operated on who was 85 years old.

And she'd been told not to have surgery. She had a pretty sizable hernia. I think it was around, total seven years. And she was worried that she was going to have a large surgery and not be able to survive that, but luckily with the ability and the advent to the robot, I was able to make smaller incisions on the side and basically treat her hernia. And she was out of the hospital in two days. She was up and walking the next day, had very minimal pain. And this is what I see a lot with my robotic patients. We don't have to make huge incisions anymore. We can do pretty complex hernias. They have less pain. They have bowel function much sooner. The matter of fact, we don't usually even wait for bowel function. They get in and out of the hospital much sooner. The robot allows you to have more precise movement and allows you to do things that you really can't do in an open fashion or laparoscopically. You tend to see every nerve, every vessel, and I think it has really worked wonders for patients. And I want to use it as much as I can on patients and kind of spread the word regarding the benefits.

Host: Yeah, well, of course robots are just undeniably cool and great that you seem to have a preference for that. And as you say smaller scars, less pain, shorter stay. By comparison then what are some of the benefits of laparoscopic surgery?

Dr. Mboumi: The benefits of having laparoscopic surgery are very similar to robot. The only exception is the fact that when we talk about hernias one of the major difference between doing a hernia laparoscopically and doing it on a robot is actually closing the defect. We talked about hernias being holes in the abdominal wall. It's really hard to sew when on the abdominal wall, because you’d be sewing upside down with the laparoscope. It can be done, but that's, it's very technically challenging and it's not commonly done.

So, most of the time when we do a laparoscopic surgery, we just basically put a patch underneath the defect to cover it up. With the robotic surgery, you're basically sewing the tissue back together and then putting a patch also. So, it's almost as if you're getting double the repair. You can do that with an open repair in which you're putting mesh in but you also closing the defect. But never before, has it been able to be done robotically and then basically where you're sewing the defect and closing it shut and doing very complex surgery. And having a very low complication, low infection rate, very little pain for patients and they go home within a day or two. So, I think it's been kind of a miracle in my opinion personally.

Host: Yeah, that's a great word to use, a miracle. And so when we talk about these two miracles, the DaVinci and laparoscopic are many doctors still doing traditional open surgery for hernias?

Dr. Mboumi: Oh, yes. So, it's a good thing you asked that because, I think it's important to mention that not every hernia is good for the robot, of course. And there's some surgeons, there are great surgeons who have really great results doing open, and as a matter of fact, our practice we also do quite a few open hernias and we have good results with them. I'd say probably 60 to 80% are probably done open still. It's a great repair still. You can have good results and patients can do really well. And also there's some hernias that are very large or patients who've had prior complications from prior hernia repairs before sometimes it's better done open. So, I don't want you to think that the robotic is the only way to fix a hernia. I think it's a great benefit, a great tool that we use when it's able to be used. But the open repair is also a very viable and a very tenacious kind of way of fixing hernias. Piggyback on that, I would say, that over the years, we have learned a couple of things when you compare the open hernia versus robotic, is the fact that a lot of times the wound infection rate can be less.

Anytime you're doing things with minimally invasive approach versus a big incision, and of course another thing is risk in diabetes patients and diabetic patients, basically, because they're just generally at risk for wound infection and have a lower threshold for immunity. So, in those patients, I think they tend to benefit more from the decrease risk if amenable to robotics, of course.

Host: I think what's great just listening to you here is it’s good to know that there are lots of options for patients that a traditional open surgery is still very common, perhaps still the gold standard, but also doctors like yourself are doing DaVinci robotic surgery, laparoscopic surgery. So, just good to know as a patient that we have options. So, this is a really educational today. Doctor, as we wrap up here, anything else you want to tell folks about hernias, diagnosing, treatment, surgery? Anything else?

Dr. Mboumi: I wanted to touch on the fact that I do see a lot of patients for hernias sometimes emergently. And, most of the story that I hear is that they've had the hernia for awhile and their doctor told them it wasn't bothering them. And they should just kind of let it be. And you know, in some cases that's reasonable and some patients do well.

Never have a problem from their hernia. And in some cases, it would actually be to their benefit to have it fixed. So, if you have a hernia and you think it's a hernia, I think it's always good to see a doctor. It doesn't have to be me or one of the partners. But of course, us at Indy Southside Surgical need off the Winkler is my partners, will be happy to see anyone for just a check up and any kind of question regarding what you think may be a hernia.

Host: I think it's such great advice that if you think you got a hernia, well, there's lots of remedies, right? We just talked about today open surgery, DaVinci, laparoscopic. Really no reason to live your life with a hernia, you just need to reach out, right? Yeah. That's great doctor. Well, thank you so much for your time. Great to have you back on again, and you stay well.

Dr. Mboumi: Well, thank you, sir. Anytime.

Host: For more information, go to Franciscanhealth.org and search hernia repair. And if you found this podcast to be helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.