Melanie Cole, MS (Host): Welcome to Meaningful Medicine, a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

I'm Melanie Cole. And joining me to talk about hernias today is Dr. William Hope. He's a general surgeon affiliated with Novant Health General Surgery in Wilmington. Dr. Hope, thank you so much for joining us today. So, we're focusing on hernias. Can you describe what a hernia even is and explain some of the most common types that you see?

William Hope, MD: Yeah, sure. Well, thanks for having me. I see a lot of hernias, and I think there's a lot of confusion about what a hernia actually is. And so, the easiest way that I explain this to my patients is a hernia is just a fancy doctor word for a hole. And you can get holes in your abdominal wall and even inside the abdominal cavity, and that can happen in a lot of different areas.

But the most common ones we see are what we call umbilical hernias, which are hernias at the belly button, or inguinal hernias, some people call them growing hernias, down in the patient's groin area.

Melanie Cole, MS: Well, thank you for explaining that. And how do you know if a hernia would benefit from surgical treatment? Should people monitor for pain and discomfort? What symptoms would we even know to see. Because sometimes, you know, with people that have an umbilical, you can sort of see it, especially if they're doing like a sit-up or lying flat. So, what are we looking for, Dr. Hope? And are we looking for symptoms that would make this something uncomfortable or do they really need to be checked?

William Hope, MD: Yeah. Well, I would say most hernias probably at least need a visit to your surgeon. And if you have a hernia, which often most patients will come in to see us because they have a bulge. They feel a bulge either at their belly button, in their groin area, or in a place they've had previous surgery, which is another common hernia that we see.

Sometimes these hernias are asymptomatic, especially at the belly button area. And they really don't bother patients. And in those cases, sometimes we can monitor these hernias. The one downside about monitoring hernias, however, is that hernias will never heal themselves. And over time, they usually get bigger.

And a lot of times when they get bigger, they start to cause symptoms to patients. So, if you are having symptoms related to your hernia pain or not being able to do some of the activities that you want to do, then I really recommend seeing a surgeon to discuss surgical treatment options. And even if they're asymptomatic to you, I do think it's worthwhile at least seeing a surgeon and seeing what your options are.

Melanie Cole, MS: And I would like to discuss the options. Before I do, people have heard the term hiatal hernia. Tell us what that is.

William Hope, MD: Yeah. Hiatal hernia is often confused with hernias because it is a hernia, a type of hernia. But this one is where there's a hole in your diaphragm muscle which separates your chest from your abdominal wall. And a lot of times in hiatal hernias, part of your stomach can go up into your chest and can cause symptoms such as reflux, acid reflux, or even trouble swallowing. And those often can be treated with medicines. But a lot of times, depending on how big those hernias are and how much stomach is in your chest, we often have some surgical options for that as well.

Melanie Cole, MS: So, we'll stick with the type that we discussed earlier. Tell us a little bit about some of the treatment options that are available

William Hope, MD: Yeah. So, surgery obviously is one of the major treatment options for hernias, if they're symptomatic. While we can watch some of these, most patients that are good candidates for surgery, we recommend some type of surgery, and it depends a lot on the type of hernia, how big it is, where it is, and how bad it's bothering patients, because a lot of these can be done electively at the patient's, you know, convenience.

And we have multiple options for how to fix these hernias. Often hernias require the use of mesh, which I know a lot of patients have questions and concerns about, but it is by far the best way to fix most of these hernias and is a very safe way to fix it. We also have robotic techniques, laparoscopic techniques, and open techniques to fix many of these hernias. And there's pluses and minuses of each of those techniques.

Melanie Cole, MS: With so many options available, Dr. Hope, what is recovery like when you fix someone's hernia, whether you're using mesh and minimally invasive or robotics? What is recovery like?

William Hope, MD: Yeah. Recovery actually can be a real thing with these hernias. And again, it depends a little bit on the size of the hernia and how they're repaired. But I tell all my patients that even though most of the time after a few days patient's pain and discomfort is better, it really takes about four to six weeks to recover from these surgeries.

And we often get a lot of questions from patients about what activities they can and can't do after surgery. And usually, that's individualized to the patient and the type of hernia. But I usually tell patients it's going to be a good month or six weeks before they're back to 100% as far as their energy level and doing all the activities that they want to do.

Melanie Cole, MS: Are there risks for not treating a hernia? Is this something that can be watchful waiting or is it really something that needs a surgical intervention much of the time?

William Hope, MD: Yeah. We do have some information about watchful waiting, especially for the inguinal hernias or groin hernias. And we do know that there's some safety in watching these hernias for a period of time. One of the major concerns, however, is these hernias can what we call incarcerate or strangulate, where intestine can go out of that hole or that hernia and get caught and can cause bowel obstructions and can cause some major life-threatening issues.

So in patients that I'm undergoing monitoring or watchful waiting with, I really have to talk to them a lot about looking out for these signs of incarceration or strangulation so that they're aware of that, if they start to feel those symptoms, that they call me or go to the emergency room so that they can get these taken care of quickly.

Melanie Cole, MS: Dr. Hope, you're giving us so much to think about and so much great information. Since hernias, as you said at the beginning, can develop at the site of a previous surgery, tell us a little bit about the clinical trial that you participated in to evaluate a potential tool for prevention

William Hope, MD: Yeah. Well, this is a really exciting trial, and we're lucky at Novant and our team here to be a part of this. This is a trial looking at the use of a mesh at the time of the initial surgery to try to prevent hernias. And so, for most of our surgeries we do, and these are open surgeries that still are very common, although laparoscopic and robotic surgery is becoming more common, we still have to do a lot of surgery where we make a big incision through the mid portion of your abdomen.

And in those cases at the end, we have to sew your tissue back together. And the hernia rates related to that can range from anywhere from 10% to almost 50% of patients. So, a lot of those patients that have had these laparotomy type incisions will go on to develop hernias. And so, this trial is looking at a potential better way while at the initial time of surgery, instead of just suturing the tissue back together, we suture the tissue back together and then use an absorbable mesh to help give that strength to see if we can reduce the rate of incisional hernias.

And we just finished enrolling patients for that trial, and we're going to follow those patients for the next five years to see if this new way to do it will make an impact on incisional hernias. And if so, I think it will be a really big game-changer for us as surgeons and patients to try to really reduce the rate of incisional hernias in these cases.

Melanie Cole, MS: That's fascinating. It's really an exciting time in your field, and I hope you'll join us and update us as that comes through. So, are there ways for the general population to reduce their risk of hernia? We've heard people say, "Oh, if you lift that too-heavy thing, you know, you're going to get a hernia." Is that a myth? Is that true? How can we reduce our risk?

William Hope, MD: Yeah. Unfortunately, there's not a ton of things you can do to reduce the risk. Some of these are genetic in nature and wear and tear in areas of our body, that just become weak over time. Now, clearly, I do talk to some of my patients, and I see many that have come in after lifting something heavy and have developed a hernia.

So, I think you need to at least be cautious when you're doing, major lifting, especially as you get older, especially if you don't have to do that. But sometimes you can develop these hernias without lifting or without strenuous activity. So, they are common problems. I will say, you know, also talk to your surgeon when you're undergoing a surgery to see if some of your surgeries could be done in what we call a minimally invasive manner.

We know the smaller the incisions we make on people's abdominal wall, the less likely they are to develop hernias. And just be aware of these. I mean, I think they're so common that one in four men in their lifetimes will develop an inguinal hernia. So, it is such a common problem. But thankfully, there's good solutions to fix them that are pretty well-tolerated.

Melanie Cole, MS: Dr. Hope, before we wrap up, I'd like to ask you how general surgery became a passion of yours. What drew you to this specialty? And give us your philosophy of care. Tell us about treating that whole person and what drew you to general surgery.

William Hope, MD: Yeah. Great question. I I'm afraid I got this honestly. My father was a general surgeon, and I think just growing up in that household and watching him work and take care of patients. And really, surgery being sort of the main focus of his life to try to help others, I think was instilled in me at a very young age.

And I really like that philosophy. I think general surgery, we have a unique opportunity to really impact patients' lives by doing a surgery, sometimes a life-saving surgery. A lot of times in hernia, we're improving patients' quality of life. So, it's very rewarding career. As you mentioned, I try to treat the whole person.

I think, you know, surgery, we have a very short time to impact a patient's care, and often, you know, we'll see the patient, operate on them, see them in our postoperative care for a few week, and then may not see them for a while. So, I really try to get to know my patients and make sure that, you know, I'm treating their surgical disease process, but also making sure that we have good impacts on their lives and healthy living styles and conditions. And so, it's a very rewarding thing.

Melanie Cole, MS: Thank you so much, Dr. Hope, for joining us today and sharing your expertise. Thank you again. And to find a physician, you can visit novanthealth.org. For more health and wellness information from our experts, you can always visit healthyheadlines.org. I'm Melanie Cole. And that concludes this episode of Meaningful Medicine, a podcast from the specialists at Novant Health.