Hernias occur when a weak abdominal wall allows a piece of the intestine or other tissue to slip through, often creating a noticeable lump. They either develop slowly over months or years or develop very suddenly.
Hernia surgery is critical for repairing the opening or weakness in the abdominal wall. If the opening is not repaired, tissues can become entrapped, weakening blood supply to those areas.
In this segment, Dr. Ivanesa Pardo, discusses treatment for hernias to help determine the most effective repair surgery for you.
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Treatment for Hernia
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Learn more about Ivanesa Pardo, MD
Ivanesa Pardo, MD
Ivanesa Pardo, MD, FACS, is a board-certified general and bariatric surgeon at Medstar Washington Hospital Center.Learn more about Ivanesa Pardo, MD
Transcription:
Treatment for Hernia
Melanie Cole (Host): Hernias can occur when a weak abdominal wall allows a piece of intestine or other tissue to slip through often creating a noticeable lump that can either develop slowly over months or years or they can develop very suddenly. My guest today is Dr. Ivanesa Pardo. She’s a general and bariatric surgeon at MedStar Washington Hospital Center. Welcome to the show Dr. Pardo. So what is a hernia? How does it even occur?
Dr. Ivanesa Pardo (Guest): Well thank you so much for having me on your show. So a hernia is a defect, that’s what we call it, in the muscle layers of the abdominal wall. In simple terms it’s a hole within the muscle layers of the abdominal wall and there are common places where hernias can occur. For instance, at the umbilicus or belly button and the groin area, those are the most common places for hernias. They can also occur at the site of previous surgical incisions and depending on where they are and if they are original hernia or after surgical incision then they can different names. These places that are most common for hernias are we call them weak spots on the muscle layers. For instance, the umbilicus or belly button that’s w here we have our umbilical cord when we were inside our mothers as babies and that is a hole that eventually will close but for some people they have a persistent opening and that opening then later in life can enlarge to become a hernia.
Melanie: If left untreated are hernias dangerous?
Dr. Pardo: They can be. If a hernia is symptomatic, meaning if they person has pain or any other symptoms related to the hernia, that’s when we talk about repairing them. Depending on what can go through that defect and it can be fatty tissue or it can be segments of intestine then that would tell us a little bit about the urgency of which we would want to repair these hernias. Because there is something called an incarceration, which is when what is going through the hernia gets stuck like it cannot be pushed back in, be that it be the intestine or the piece of fatty tissue. And then there is something even worse called strangulation, which means that organ or piece of fatty tissue that’s stuck is losing its blood supply so it’s starting to die and that would be a surgical emergency.
Melanie: So if somebody notices this little bump Dr. Pardo because sometimes you just notice it and you go “Oh what is that?” then is that the time to go see a physician? Do you wait to see if it goes away, do you try and push it back down through? What do you do if you notice it?
Dr. Pardo: So if you notice a lump and it’s not tender and there are no changes on the skin you can always just push it to assess yourself if you’re dealing with something that is kind of going in and out. Hernias for the most part when you do certain movements that are called Valsalva maneuvers for instance coughing, sneezing, straining, you can feel that that lump may become larger or push out or even become a little bit tender. If you find these characteristics it would be cautious to go to the doctor to get the diagnosis confirmed. That does not necessarily mean that you’re going to get surgery offer, in fact you can go to your primary care doctor to have this evaluated. And they’re going to be able to asses if it is a hernia. If they’re in doubt they can order some testing or they can send you to a surgeon to better confirm the diagnosis.
Melanie: Are there some common activities that cause them? We used to hear oh if you lift that improperly you might get a hernia or something that’s too heavy for you, are there some things that you’d like to let the listeners know that they can do to reduce their risk of hernia?
Dr. Pardo: So there’s definitely horror stories of a person that exercises a lot and does a lot of heavy lifting and then they can feel a pop and those are hernias that occur all of a sudden. And there’s no limitation that I would put on a person to not do an activity in order to avoid a hernia, but somebody that does have a hernia may want to be careful when doing such activates, like lifting, because then the hernia can become symptomatic, can become incarcerated, and enlarge overtime so you can definitely become problematic. If you don’t have a hernia, I would say definitely don’t pass beyond your own limits and every person knows for the most part what their own limits are.
Melanie: So when does it require surgery Dr. Pardo and what’s involved in hernia surgery?
Dr. Pardo: So I recommend surgery when the defect is large enough that even if it’s reducible, which means even if the defect going through, if it’s large enough where a segment of intestine could get stuck where we talked about incarceration and strangulation, I would recommend to electively repair it before that were to happen. Of course if it does happen then you know that’s more of an emergency surgery. In surgery terms, elective is always a better way of repairing because everything is more under control. The way that we repair hernias, there are many ways. We could say there’s old fashion which is called open repairs which equals larger incision. And then there’s the more modern repairs which we call minimally invasive. And that can be laparoscopic or robotic. And that would depend on the availability of the facility where you have that and of course the skills of the surgeon. Most hernias that need repair will most likely require a mesh implantation. And a mesh is a screen, it’s a synthetic material and what it does is it reinforces the muscle layers where the defect, where the hernia, is. So we reduce the chances of the hernia coming back after it’s been repaired so with the advent of mesh what we’ve created is a hernia that would have had almost a 50% chance of coming back, now we’ve reduced it to 3-5% chance of coming back. So I would say that it is a conversation that you would have with your surgeon if you do need repair and if you do need mesh.
Melanie: And you mentioned that the chances of it coming back. So depending on the type of repair that you have, the chances of it coming back or coming in a different spot, what do you tell people about those?
Dr. Pardo: It’s very important when healing from the surgery that we limit those activities that cause increased pressure of the abdomen like lifting, straining, for usually about a time of 6 weeks. And that is to let the tissues heal and the mesh incorporates and be as strong as it can be in order to procedure with those activates. Those would reduce the chances of the hernia coming back. Now we try to optimize the patients prior to surgery so people with diabetes. People who are obsess, people who are smokers, we try to improve all those things before surgery because that would give you the best result possible.
Melanie: So wrap it up for us Dr. Pardo with your best advice about people who might notice that they have a hernia or who want to avoid one if they possibly can, and what do you tell people every day about hernia, hernia repair, and possible prevention?
Dr. Pardo: So definitely if you have surgery before because you can get hernias at incisions sites, avoid heavy lifting especially know your own limits so you don’t pass those limits because that’s when your risk of creating hernia is. If you ever notice a lump and you’re unsure go to your primary care doctor and they will be able to identify if it is indeed a hernia and if they’re unsure they will send you to see a surgeon. Of course you can always see a surgeon directly to assist in the diagnosis. And depending on what is found, then we would have the conversation as far as does it need to be repair and if so what is the best approach for the specific person.
Melanie: Thank you so much for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to MedStarWashington.org. This is Melanie Cole, thanks so much for listening.
Treatment for Hernia
Melanie Cole (Host): Hernias can occur when a weak abdominal wall allows a piece of intestine or other tissue to slip through often creating a noticeable lump that can either develop slowly over months or years or they can develop very suddenly. My guest today is Dr. Ivanesa Pardo. She’s a general and bariatric surgeon at MedStar Washington Hospital Center. Welcome to the show Dr. Pardo. So what is a hernia? How does it even occur?
Dr. Ivanesa Pardo (Guest): Well thank you so much for having me on your show. So a hernia is a defect, that’s what we call it, in the muscle layers of the abdominal wall. In simple terms it’s a hole within the muscle layers of the abdominal wall and there are common places where hernias can occur. For instance, at the umbilicus or belly button and the groin area, those are the most common places for hernias. They can also occur at the site of previous surgical incisions and depending on where they are and if they are original hernia or after surgical incision then they can different names. These places that are most common for hernias are we call them weak spots on the muscle layers. For instance, the umbilicus or belly button that’s w here we have our umbilical cord when we were inside our mothers as babies and that is a hole that eventually will close but for some people they have a persistent opening and that opening then later in life can enlarge to become a hernia.
Melanie: If left untreated are hernias dangerous?
Dr. Pardo: They can be. If a hernia is symptomatic, meaning if they person has pain or any other symptoms related to the hernia, that’s when we talk about repairing them. Depending on what can go through that defect and it can be fatty tissue or it can be segments of intestine then that would tell us a little bit about the urgency of which we would want to repair these hernias. Because there is something called an incarceration, which is when what is going through the hernia gets stuck like it cannot be pushed back in, be that it be the intestine or the piece of fatty tissue. And then there is something even worse called strangulation, which means that organ or piece of fatty tissue that’s stuck is losing its blood supply so it’s starting to die and that would be a surgical emergency.
Melanie: So if somebody notices this little bump Dr. Pardo because sometimes you just notice it and you go “Oh what is that?” then is that the time to go see a physician? Do you wait to see if it goes away, do you try and push it back down through? What do you do if you notice it?
Dr. Pardo: So if you notice a lump and it’s not tender and there are no changes on the skin you can always just push it to assess yourself if you’re dealing with something that is kind of going in and out. Hernias for the most part when you do certain movements that are called Valsalva maneuvers for instance coughing, sneezing, straining, you can feel that that lump may become larger or push out or even become a little bit tender. If you find these characteristics it would be cautious to go to the doctor to get the diagnosis confirmed. That does not necessarily mean that you’re going to get surgery offer, in fact you can go to your primary care doctor to have this evaluated. And they’re going to be able to asses if it is a hernia. If they’re in doubt they can order some testing or they can send you to a surgeon to better confirm the diagnosis.
Melanie: Are there some common activities that cause them? We used to hear oh if you lift that improperly you might get a hernia or something that’s too heavy for you, are there some things that you’d like to let the listeners know that they can do to reduce their risk of hernia?
Dr. Pardo: So there’s definitely horror stories of a person that exercises a lot and does a lot of heavy lifting and then they can feel a pop and those are hernias that occur all of a sudden. And there’s no limitation that I would put on a person to not do an activity in order to avoid a hernia, but somebody that does have a hernia may want to be careful when doing such activates, like lifting, because then the hernia can become symptomatic, can become incarcerated, and enlarge overtime so you can definitely become problematic. If you don’t have a hernia, I would say definitely don’t pass beyond your own limits and every person knows for the most part what their own limits are.
Melanie: So when does it require surgery Dr. Pardo and what’s involved in hernia surgery?
Dr. Pardo: So I recommend surgery when the defect is large enough that even if it’s reducible, which means even if the defect going through, if it’s large enough where a segment of intestine could get stuck where we talked about incarceration and strangulation, I would recommend to electively repair it before that were to happen. Of course if it does happen then you know that’s more of an emergency surgery. In surgery terms, elective is always a better way of repairing because everything is more under control. The way that we repair hernias, there are many ways. We could say there’s old fashion which is called open repairs which equals larger incision. And then there’s the more modern repairs which we call minimally invasive. And that can be laparoscopic or robotic. And that would depend on the availability of the facility where you have that and of course the skills of the surgeon. Most hernias that need repair will most likely require a mesh implantation. And a mesh is a screen, it’s a synthetic material and what it does is it reinforces the muscle layers where the defect, where the hernia, is. So we reduce the chances of the hernia coming back after it’s been repaired so with the advent of mesh what we’ve created is a hernia that would have had almost a 50% chance of coming back, now we’ve reduced it to 3-5% chance of coming back. So I would say that it is a conversation that you would have with your surgeon if you do need repair and if you do need mesh.
Melanie: And you mentioned that the chances of it coming back. So depending on the type of repair that you have, the chances of it coming back or coming in a different spot, what do you tell people about those?
Dr. Pardo: It’s very important when healing from the surgery that we limit those activities that cause increased pressure of the abdomen like lifting, straining, for usually about a time of 6 weeks. And that is to let the tissues heal and the mesh incorporates and be as strong as it can be in order to procedure with those activates. Those would reduce the chances of the hernia coming back. Now we try to optimize the patients prior to surgery so people with diabetes. People who are obsess, people who are smokers, we try to improve all those things before surgery because that would give you the best result possible.
Melanie: So wrap it up for us Dr. Pardo with your best advice about people who might notice that they have a hernia or who want to avoid one if they possibly can, and what do you tell people every day about hernia, hernia repair, and possible prevention?
Dr. Pardo: So definitely if you have surgery before because you can get hernias at incisions sites, avoid heavy lifting especially know your own limits so you don’t pass those limits because that’s when your risk of creating hernia is. If you ever notice a lump and you’re unsure go to your primary care doctor and they will be able to identify if it is indeed a hernia and if they’re unsure they will send you to see a surgeon. Of course you can always see a surgeon directly to assist in the diagnosis. And depending on what is found, then we would have the conversation as far as does it need to be repair and if so what is the best approach for the specific person.
Melanie: Thank you so much for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to MedStarWashington.org. This is Melanie Cole, thanks so much for listening.