Transcription:
Hernias

Joey Wahler (Host): We've heard it said that you shouldn't lift something too heavy because you might get a hernia. Right. But is that actually true? We're discussing what a hernia is and how it's addressed. This is Flushing Hospital Med Talk, a podcast sponsored by Flushing Hospital Medical Center.

Thanks for listening. I'm Joey Wahler. Our guest, Dr. Noman Khan, a Bariatric and General and Minimally Invasive Surgeon as well as Chair of Robotic Surgery at Flushing Hospital Medical Center. Dr. Khan, thanks for joining us.

Noman Khan, DO (Guest): Thank you for having me.

Host: Great to have you with us. So first simply put what is a hernia for those unfamiliar and what typically causes it?

Dr. Khan: So the easiest way to define a hernia would be basically it's a weakness in the abdominal wall, usually. And through that abdominal wall, you can have a protrusion. So, the abdominal contents, can be your intestines, can be the fat inside your body, and those can actually protrude through a weakness in your abdominal cavity that either you were born with or you acquired over time. Of there's various types and we'll cover that as well.

Host: Well, why don't we go ahead and do that? You led me right into my next question beautifully. So there are different types. What are they and what distinguishes them?

Dr. Khan: So the most common type that you'll usually run into are what people call groin hernias, which we call inguinal hernias. So in those hernias, what happens is basically there's a weakness in the lower area of the abdominal wall. Some people are born with it and some people acquire it over time, from such things as lifting, chronic constipation and so on and so forth. So these are basically hernias that come through the groin area, and sometimes can be noticed as a bulge or an uncomfortable bulge in the area, especially in men leading down into the scrotal area as well.

The next types are femoral hernia, which is more closer to the thigh area, which we more commonly see in women, and that's in the top of the inner. And those can be particularly uncomfortable and at times, dangerous because they can become trapped or strangulated, incarcerated as we sometimes call it, which I'll also go into a little bit more.

An umbilical hernia is right at the belly button, or umbilicus as we call it and that's a protrusion that you can see there. Some people see that as basically more of an outie belly button. They may see they've always had it. In some, cases which, they could be born with.

And then finally we have hiatal hernias or hiatus hernias. So those are hernias that basically are a little bit different. They are not visible from the outside and they can actually be where your stomach is protruding from your cavity into your chest.

So that's a little bit of a different kind of hernia. And I think we'll talk more about abdominal wall hernias today.

Host: Yes. And speaking of which, just to follow up on something you mentioned there, you said that some people are more prone to getting a groin hernia. Right. And I'm wondering therefore, to go back to what I mentioned at the top, where sometimes people might be leery of lifting something too heavy, because they're worried about a hernia. Is it normally if they get one more because they were prone beforehand or because of the act, or maybe a combination of the two?

Dr. Khan: It can be a combination of the two in most cases. And that's a good question. Often people ask me well, if I exercise a lot or if I lift frequently, am I going to end up with a hernia? And the answer is no, not necessarily. However, if you've already have a weakness in that area, that again you could have been born with, could be formed over time from repeated lifting, especially if you lift incorrectly.

So if you increase your intrabdominal pressure, meaning you lift incorrectly, you don't bend your knees. You lift very heavy objects directly off of the floor. Then you may increase your intra-abdominal pressure and give more pressure in that weakness that would cause you to form a hernia.

However, in some cases you're already born with a small hernia. And that hernia inevitably gets larger over time and that can be due to the intra-abdominal pressure from things like lifting, but it can also be due to things like straining, constipation, a heavy cough, especially in smokers, things like that can also lead to hernias or lead increase in a size of a hernia that you already have.

Host: Gotcha. Now, are there always obvious hernia symptoms to a person and which are the most common?

Dr. Khan: So, that's a good question because a lot of times people ask me well I have a hernia, but I don't feel anything and is that still a problem? And the answer is sometimes yes or no. So in respect to what you can feel, you may just see a swelling or a bulge. You may see a pouch in the area, especially in the groin. You may notice that one side sticks out more than the other, and that particular side, could also have an aching sensation, a pulling, or you can even feel like, sometimes it pops out when you lay down and relax and you push it back in, it goes right back in. That's almost a sure sign that you have a hernia, and that's something that you probably have repaired.

Host: Yeah, I can recall when I had my hernia in my right groin several years ago that I had already been diagnosed and was scheduled for surgery, but I had to wait about a week or two to have it done. And there was one night in New York City where I was trying to find my car that was parked in an area that I wasn't used to parking in.

And I couldn't find the car and I was walking and walking and going in the wrong direction. And that hernia, I could feel it popping through more and more, and I've never been in more agony in my life. I can laugh about it now. And as you alluded to doc, it wasn't until I got into the car and was able to sit and relax that finally it went away. I didn't know if I was going to make it that night. That was a little rough.

Dr. Khan: Yeah. That sounds particularly uncomfortable. And in cases like that, especially, when I see patients with hernias like that, that can make you bad, uncomfortable, and that need you to lay down and reduce. I would 100% recommend repair.

Host: Absolutely. And so of course I went ahead and got that done. Now, if you do have a hernia, what are the treatment options?

Dr. Khan: So the first thing you want to do, if you have a hernia, is want to speak with your primary care physician about the fact that you suspect you have a hernia. Usually just by physical exam, your primary care provider tell if you do indeed have a hernia. Very rarely do we need imaging, such as a CAT scan or other things to diagnose a hernia since they're usually pretty obvious on exam.

Now, once you've established, you have a hernia, your primary care physician is going to send you to someone like me. And basically a surgeon can decide and discuss your treatment options with you on what needs to next. You don’t want to ignore hernias because it's hard to tell which hernia is exactly are of high concern and low concern.

And your surgeon can have that conversation with you on whether or not it's necessary to repair. Early repair is usually the better option because hernias grow over time almost without exception. So you do want to approach early on with your primary care and say, I may have a discomfort here. Is it a hernia? Now, if you've decided yes, it is a hernia with your primary care, then the next step would be to speak with a surgeon.

Host: And so that's where you would come in and what are the options? I know that something called the mesh procedure is the most common right?

Dr. Khan: That's correct. So mesh is a part of the many types procedure that we do. So I'm going to start from types of hernias. Again, I'm go back to what we discussed because it's important to consider type of hernia before we talk about how we can repair it. So the most common type as I had suggested earlier is the inguinal hernia or the groin hernia. Some people call it. That hernia can be repaired basically in two ways or three, if we include robotic, which I'd like to get into as well. The first of which is called open repair and that's where an incision is made over the top of the groin hernia itself. And the groin hernia is reduced back into the abdominal cavity, the weakness or the opening, which is the hernia itself is found and that's repaired.

And, almost without exception, a mesh is placed over that region, which you alluded to. And then the tissue over the mesh is closed and then the incision itself is closed. So what this does is it reinforces the weakness in the abdominal wall. The mesh is a very necessary part in most hernias because the tissue is already weak.

So just repairing it with suturing, would result in a unacceptably high rate of them coming back or what we call recurrence rate. So therefore we put a mesh over the top of the hernia to sort of give that abdominal wall more strength. The other options are laparoscopic or robotic.

So laparoscopic, is a word that basically indicates that we do something minimally invasive. We make small incisions on the abdominal wall and we enter the abdominal wall with instruments and a camera, and we can repair the hernia without making a larger incision. Now, the advantage of this is that it basically allows you to heal faster. The recovery is shorter. And most people have less pain after a laparoscopic repair. chances of the hernia coming back, the chance of infection, all of them seem to equivalent between open and laparoscopic repairs and open repairs are still done more widely nationwide than laparoscopic repairs.

Now, robotic repairs are very similar to laparoscopic repairs, except of course using a robot. So we have small incisions again, we're entering the abdominal cavity. And we have a robot with instruments on it. does the It gives the surgeon an advantage in that we can operate in much smaller spaces.

We have much more precise instruments, we can see things in 3D and high definition inside your body without having to cut and make large incisions and open them up. So robotic surgery is fast gaining traction as far as hernias go, and we're seeing more and more surgeons adopt it as a way to do a hernia minimally invasive.

Now the umbilical hernia is, also, fixed in a similar fashion. You again, have both options and they're very similar. You can make an incision over the top of the umbilical hernia and you can repair it with mesh, or you can do a laparoscopic repair or robotic repair, which again gives you the same advantages.

Another type of hernia that we're seeing more and more and many people come to us with is an incisional hernia. What that means is that you've had surgery before. So if you have an incisional hernia, it may be anywhere in the abdomen where you've had surgery, whether or not it was done with a large incision or a small incision, you may form a hernia.

These hernias as well the repair options are very similar. We can make a large incision over the hernia itself and repair it with a mesh which may be inside of your abdomen or outside of your abdomen. We can laparoscopically repair it and approach it from the inside. And we can, again, robotically repair it.

In the robotic repair, the big advantage with the incisional hernias is in many cases, they can be extremely complex. So if they are complex than the robot gives us the advantage of having the ability to do very, very complex hernias and still for the patient, have very small incisions. It's a hernia that may have needed a very, very large incision now through small incisions.

And in most cases I have my patients tell me even with complex repairs or robotic inguinal or with robotic ventrals, ventral refers to the front side of the abdomen that they are on their feet the same day, and that they have minimal to no pain, three to five days after surgery.

Host: Wow. That's after the robotic?

Dr. Khan: Correct. So our focus, as you said, in my introduction, I'm a minimally invasive and robotic surgeon. Now robot does imply minimally invasive on its own. So does laparoscopic. And that's why we try to focus now more on seeing who might be a good candidate for a robotic or laparoscopic surgery, because it really is such a big difference in recovery and pain.

And we love to see our patients come in and say I barely needed any pain medication and I was on my feet the same day. And would you believe it? Three days later I have no pain and that’s a great feeling.

Host: And so to sum up here, even though we're talking about obviously the different kinds of hernias and treatments that you just mentioned, in a nutshell, what's the recovery time difference, typically robotic versus traditional?

Dr. Khan: With a traditional hernia surgery, we may see pain for a week or longer. And of course you have a larger incision. So sometimes that's also a cosmetic concern for a patient. You may have patients who want the minimally invasive surgery because they don't want a large scar on their abdomen or their groin.

And of course, that's completely valid. So, not only does it give the advantage of less pain, quicker recovery, quicker back to activity, but also there's no denying that the cosmetic appeal of having a smaller incision on your abdomen or a few smaller incisions trumps having a larger incision on your abdomen that to some people might be quite unsightly.

Host: , So overall, considering everything we've covered and you've been very thorough in covering it, Doc, what's the main message you have for people that may be considering hernia surgery?

Dr. Khan: Well, the main thing is number one, you want to make sure that you have a diagnosis and you meet a surgeon. So as I said, it's early diagnosis is best, not hesitating to basically talk with your physician about the fact that you may be concerned about a hernia because late diagnosis, late treatment, that's where we run into the complications with the hernia itself.

And of course, I wanted to mention that if you do have a hernia and it goes from something that you could easily push back in or something that never bothered you before, let's say you decided to not listen to this podcast and you did ignore it for some time and now it's stuck; well, you want to immediately go to your physician or to the emergency room because a hernia with the contents that are in your abdomen, which include your intestine, stuck is now a surgical emergency.

So that's part of the reason that you don't want to delay treatment. So the number one message is if you have a hernia, talk with your physician about it, make sure that you have an early diagnosis and treatment because oftentimes, the surgery may be a lot more staightforward than you imagined. That's the first thing.

The second thing is, well, let's try to prevent hernias from growing or from forming in the first place. So heavy lifting, especially lifting that's well outside of the limits of what you should be doing. Incorrectly lifting, chronic constipation, chronic meaning that you've had constipation for a long time. And of course, physician will tell you this, but don't smoke because smoking can cause chronic cough, but also it can, weaken tissue in the area even further. So it can cause hernias to get bigger. Now, once we have established, you have a hernia you want to meet with a surgeon who's gonna give you some options. You may choose minimally invasive repair as your option because you say, well, I prefer a slightly faster recovery. I prefer smaller incisions. And this is a surgery that I like so you may pick the surgeon who does that. And I think that to have the laparoscopic or the robotic option and be able to offer that to our patients huge plus for us.

Host: Absolutely. It sounds like robotic surgery just in the medical field in general, continues to grow almost everywhere. Well, folks we trust you're now more familiar with what a hernia is and how it's treated. Dr. Noman Khan, thanks so much again.

Dr. Khan: Pleasure. Thank you so much for having me.

Host: Same here. And a reminder that all content of this podcast is intended for general information purposes only not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast. To learn more about the surgical services offered at Flushing Hospital Medical Center, please call 718-670-3135. For more information about all the services Flushing Hospital Medical Center offers, please visit flushinghospital.org. If you found this podcast helpful, please share it on your social media.

And thanks for listening to Flushing Hospital Med Talk, a podcast sponsored by Flushing Hospital Medical Center. Hoping your health is good health. I'm Joey Wahler.