Transcription:
Understanding Hernias

Prakash Chandran: Today, we're talking about hernias, which include the different types of hernias that exist and how they're treated. We're joined by an expert today, Dr. Roberto Cantu, Jr. a Vice Chairman of the Department of Surgery at Flushing Hospital.

This is Flushing Hospital Med Talk. I'm your host, Prakash Chandran. Dr. Cantu, thank you so much for joining us today. Can you just tell us broadly what exactly is a hernia?

Roberto Cantu, MD: Hernia is best described as a defect or weakness in the abdominal wall.

Prakash Chandran: Okay. And before we get into the different types, like how exactly does that express? Does that just look like a little bulge that is coming out of your stomach?

Roberto Cantu, MD: Yeah, correct. A bulge coming out in the area where the hernia is, and sometimes pain.

Prakash Chandran: So, let's talk about the different types of hernias. What different types are there and how do they differ from one another?

Roberto Cantu, MD: Well, the main way to differentiate hernia is by location. If one occurs in the belly button, it's called an umbilical hernia. If one is caught in the groin, it can be an inguinal hernia or a femoral hernia. And then, you have the incisional hernias, which occur after surgery.

Prakash Chandran: Okay. And talk to us about the symptoms. How can you tell the difference between a hernia or another type of injury?

Roberto Cantu, MD: The main way you can tell is you see a bulge in the area, that continues to grow with time.

Prakash Chandran: Okay. And talk a little bit more about the symptoms. You're saying that there's a bulge in the area, it continues to grow over time, and does it get more painful? Like how do you know it's actually a hernia?

Roberto Cantu, MD: Just by the bulge and the fact that it goes away when they lie down. So, any increase abdominal pressure will cause it to bulge and relaxing or lying down will cause it to go away. That's the best way to tell is there a hernia there, the fact that it goes away.

Prakash Chandran: I see. So, it goes away when you're kind of in a more relaxed position.

Roberto Cantu, MD: Correct.

Prakash Chandran: And out of curiosity, is there another type of condition that hernias most commonly get confused for?

Roberto Cantu, MD: Masses, you know, like a lipoma; subcutaneous masses. Masses in the area.

Prakash Chandran: Okay. So, taking a step back, what are some of the most common reasons for developing a hernia? I've heard that sometimes it's due to exertion. But maybe you can broadly speak about how people develop them in the first place.

Roberto Cantu, MD: Well, there's certain questions we always ask. One is a chronic cough, which will cause a hernia; chronic constipation. Pregnancy is also a cause, because of the increased abdominal pressure. And also, difficulty with urination can be a cause like in patients with prostate problems. And the last cause, which is the one we worry about the most, is cancer. Cancer can cause a hernia.

Prakash Chandran: I want to talk about people that are potentially more susceptible to getting hernias. You talked about people with prostate problems, so that's one camp. Is there anyone else that is more at risk?

Roberto Cantu, MD: Well, chronic smokers are at risk. Anyone who does a lot of heavy lifting, I forgot to mention that. And anybody with a long history of chronic constipation can develop a hernia also.

Prakash Chandran: So, what is the problem with a hernia? Because I know my father-in-law, for example, had a hernia that he didn't really get addressed for quite a long time. He eventually got surgery and we're going to talk about treatment options soon. But if left untreated, can a hernia heal on its own? And what are the dangers if it isn't treated?

Roberto Cantu, MD: It will not heal on it's own. And the most dangerous complication of a hernia is that goes to a size where intraabdominal organs go into it and they can become trapped and require emergency surgery.

Prakash Chandran: Can you describe the different surgical options to treat a hernia? And what type do you offer at Flushing Hospital?

Roberto Cantu, MD: Well, the different types vary by the procedure that we do. The first and the most common procedure we do is an open repair with mesh, which is a standard operation for like a single hernia. But we also can do it laparoscopically or robotically, but again with mesh. Mesh is very important to reduce any kind of tension on the tissues that'll cause a recurrence of a hernia.

Prakash Chandran: Okay. And for the lay people in the audience, what exactly does a repair with mesh mean?

Roberto Cantu, MD: It means that we fix the hernia, reduce it, or take it out. And then, we put the mesh in its place where the area of weakness is and it prevents another hernia from forming.

Prakash Chandran: Okay. And what about some of the non-surgical treatment options?

Roberto Cantu, MD: Well, the only non-surgical treatment options are something called the truss, which is a belt that they wear to keep the hernia in place or abdominal binder, again for the same reason, to keep the hernia in place. The problem with those is that over time they cause scar tissue and it makes it difficult to repair.

Prakash Chandran: Okay. So, really the gold standard for hernia treatment are surgical measures that you mentioned. Is that correct?

Roberto Cantu, MD: Correct. Surgical repair is the only way to fix a hernia properly. Correct.

Prakash Chandran: And what about scarring after the surgery itself? Is that something that people need to be concerned with?

Roberto Cantu, MD: All surgery leaves a scar. People think that laparoscopic surgery, robotic surgery will not leave a scar, but we still make an incision to fix the tissues. So, they think there's going to be no scar with laparoscopic robotic. And then, they're surprised when they see these port sites where we did the surgery.

Prakash Chandran: And since you mentioned two types of surgeries, are there ways that you decide which surgical treatment to use when treating a hernia?

Roberto Cantu, MD: There's indications for both the open and laparoscopic. If someone has previous surgeries, it's better to do it open than laparoscopic because you can cause injury with the scar tissue from the previous surgery. So, there are reasons for doing it different ways.

Prakash Chandran: And what is the recovery time like?

Roberto Cantu, MD: Well, after an repair, we generally recommend three to four weeks recuperation. Laparoscopic or robotic, usually two weeks.

Prakash Chandran: And once they get it treated, is this a one-time treatment or is this something that they have to continually come to get looked at and potentially opened up again?

Roberto Cantu, MD: Generally, it's a one-time treatment. Like I said, mesh is that would reduce their recurrence rate tremendously. With the old open repairs without mesh, there was a higher recurrence rate. Now, this is much, much lower, but still there's always a chance that you can recur, you know. No matter what surgery we do, there is never a guarantee it's a hundred percent, you know, cure rate or heal rate.

Prakash Chandran: And so, speaking of the mesh, is that something that the patient can feel after the surgery?

Roberto Cantu, MD: The mesh cannot be felt by the patient. It's underneath their tissue, so they'll never feel the mesh, but it's there permanently preventing a recurrence.

Prakash Chandran: Okay. And that doesn't affect the body at all, right? There's no side effects.

Roberto Cantu, MD: Correct. No side effect with the mesh, no.

Prakash Chandran: Okay. So, taking a step back, if someone feels like they have a hernia, what should they do? Should they go to see their primary care physician first, or should they go straight to a specialist?

Roberto Cantu, MD: Well, they should go see their primary care physician always first. And then, he should refer them to a surgeon. And then, we take it from there.

Prakash Chandran: Okay. And is there a certain like demographic or age group that's more susceptible to getting hernias or does it affect all ages?

Roberto Cantu, MD: It affects all ages, but most commonly occur in the really younger age groups, and the really older age groups also. Those are the main two troops we see.

Prakash Chandran: Okay. And my assumption is the younger age groups is they're very active, they're potentially lifting a lot. And then, the older age groups, because of all the chronic problems that you mentioned, right?

Roberto Cantu, MD: Right. The worse healing and the malnutrition, stuff like that. Yes.

Prakash Chandran: So Dr. Cantu, just before we close here, is there anything else that you'd like to share with our audience, just the takeaway that you'd like them to have?

Roberto Cantu, MD: I guess just the dangers of a hernia. The main thing that I would make sure that they understand, the dangers of not seeking treatment in those.

Prakash Chandran: Well, Dr. Cantu, this has been a great conversation. Thank you so much for your time.

Roberto Cantu, MD: Oh, thank you very much. You're welcome.

Prakash Chandran: That was Dr. Roberto Cantu, Jr., Vice Chairman of the Department of Surgery at Flushing Hospital. Thanks so much for listening. For more information about the services Flushing Hospital offers, you can visit our website at flushinghospital.org/podcasts.  This has been  Flushing Hospital Med Talk,  I'm your host, Prakash Chandran. Thanks, and we'll talk soon.