Jaime Lewis (Host): According to the FDA, over 1 million hernia repairs are performed annually in the United States. While hernias are common, advances in surgical techniques now offer patients more options than ever before for treatment and recovery. Here to discuss hernia repair and the latest surgical approaches is Dr. Amanda Berlekamp, a General Surgeon at Southwest General Health Center. She'll talk about different surgical techniques, including robotic assisted surgery, and what patients should know about their treatment options. This is Southwest General Health Talk, the podcast from the specialists at Southwest General Health Center.

I'm Jaime Lewis. Dr. Berlekamp, thank you for being here today.

Amanda Berlekamp, DO: Thank you for having me.

Host: Could you start perhaps by explaining what a hernia is exactly and what it typically requires? What typically requires surgical repair?

Amanda Berlekamp, DO: So, a hernia is a weakness in usually the abdominal wall, where organs from the inside start to push their way out into the outside, forming a palpable lump or a bulge that patients come in complaining about. Most commonly they occur at the belly button or in the groin area or at former sites of surgery where patients have had prior incisions.

It causes pain, discomfort when those tissues start to push through, and so that's generally when we see patients. In the worst case scenarios, when the bowel or other organs start to push through, it causes emergencies where patients come in with nausea, vomiting, they can't pass gas or have a bowel movement, and we do have to go for emergency surgery to repair those. So, we like to fix them before it gets to that point.

Host: And when they do come in to see you for a hernia, what factors determine whether you use open surgery, laparoscopic, or robotic repair?

Amanda Berlekamp, DO: Those are the three ways to repair them now, but that decision is very individualized. It depends on the patient's medical conditions, their former surgeries, the hernia itself, where it's located, if they've had prior repairs in that area, and so it does become very unique to each patient. In general, we prefer to repair them through a minimally invasive approach, either laparoscopic or robotically.

Robotic surgery really has taken over as the main way to repair hernias now. There are certain cases where laparoscopic surgery would still be the recommended way to start and then rarely would open surgery be needed, but it's still possible. Again, usually in those emergent cases or with rather complex hernias, such as recurrent ones, if there are stomas involved, other problems on the abdominal wall.

Host: Let's talk a little bit about robotic surgery because I think there's often confusion about what that entails. Can you explain how a robot assists in the surgery and what is your role as the surgeon during the procedure? 

Amanda Berlekamp, DO: The robot is essentially an amazing laparoscopic tool. With laparoscopic surgery, we use long, straight instruments to operate using a camera with two dimensional vision. We can operate two instruments at a time, just like we're using our hands. But with robotic surgery, that changes a lot of that.

We're able to use four robotic arms, that are set in place at the patient's bedside. And then the surgeon enters into a console directly next to the bedside. That console gives us three dimensional vision and control of all four of those robotic arms. So we control the camera, exactly what we're seeing, all of our retraction.

Those instruments also are wristed. So it's like using our hands inside of the patient's abdomen, which makes surgery more accurate, precise, delicate, so that patients have better recovery, safer surgery, and get back to their normal activities quicker.

Host: That's so incredible. I know that a lot of patients will have questions or concerns about the use of surgical mesh. I know that that's a thing that comes up often in, in terms of what patients are concerned about. Can you explain a little bit about why mesh is so commonly used and address some of those concerns that patients might have about it?

Amanda Berlekamp, DO: Yeah, mesh is used to reinforce the closures that we're doing. So we're closing these defects and then reinforcing that area with the mesh behind it. It prevents the hernia from coming back again and without using a mesh, the chance of it coming back is twice as high as if we do not use a mesh. And so really, most, if not all, the repairs we're doing now are using meshes, unless there are specific cases of emergency surgery with contaminated fields, and that gets into some of the nitty gritty of hernia repairs.

Host: When a patient is recovering, what does that typically look like after hernia surgery? Are there differences in recovery time between open, laparoscopic, and robotic approaches?

Amanda Berlekamp, DO: Sure, so through the minimally invasive approaches, people have small incisions, three incisions usually are what we use, high up on the belly wall or down the left side of the abdomen. Those incisions are small, they're about the width of a fingernail, and it is much less damaging to the muscle than cutting down through it, through a traditional open incision, which allows patients to get back to, again, daily life faster, back to their activities with less pain also after surgery.

Host: As far as complications go, what are some of those potential complications that patients should be aware of and how do you help manage those if they occur?

Amanda Berlekamp, DO: The most common complications of any surgery are bleeding and infection. Thankfully, with something like this, that's very low to begin with, virtually unheard of and unseen. But anytime you make an incision in the skin, that is a potential. And then for these surgeries in particular, depending on where exactly we're working, what kind of hernia it is, there's chances of injuring the bowel or certain blood vessels nearby, which again, thankfully is very low.

Mesh infection is a possibility, so it is putting a foreign body inside of the body. There is a chance of infection, again, very low, which is why we do these surgeries and reinforce them with these meshes. And then there's also the chance that even despite our best efforts at repair and placing a mesh, they still can come back again in the future, down into the single digits of percentage of seeing those recurring.

Host: You mentioned that a person might notice first that there's a bulge or some kind of discomfort. For anybody who's listening who thinks they might have a hernia, what are the warning signs they should look out for and when should they seek medical attention?

Amanda Berlekamp, DO: The first really stage of the hernia is it's moving in and out. It's there, but it's barely noticeable by the patient. It's not interfering with their daily life. Sometimes we see patients at that point and we do just watch them to see if it becomes symptomatic. But if it starts hurting them, interfering with how they're moving throughout their day, activities that they want to do, those are the first steps or indications for repairing that hernia.

Host: Well, is there anything else that you want to share with the audience about hernia repair or what they should know if they're considering surgery?

Amanda Berlekamp, DO: Yeah, I think, honestly, it's a wonderful surgery to have nowadays, with these minimally invasive techniques that we have. The robot can do amazing things and technology is only getting better, which means safer and faster recovery for patients. So if anyone is considering having it repaired, come in and talk and let's go over things and get it taken care of for you.

Host: Thank you, Dr. Berlekamp for the work that you do and for joining us today.

Amanda Berlekamp, DO: Thanks. Happy to be here.

Host: That was Dr. Amanda Berlekamp, General Surgeon at Southwest General Health Center. To schedule an appointment or learn more about surgical services, visit swgeneral.com. And And thank you for listening to Southwest General Health Talk, the podcast from the specialists at Southwest General Health Center.