Caitlin Whyte (Host): Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm Caitlin Whyte. And with me is Dr. Eric DeAngelis, a general and bariatric surgeon at UM Charles Regional Medical Center.

Today, we're diving into the topic of hernias and discussing the treatment options available for this common condition. Now, doctor, many people have heard of a hernia, but aren't quite sure what it really means. So to start us off, can you tell us what is a hernia and how does one develop?

Dr. Erik DeAngeles: So, put very simply, a hernia is when an organ or a tissue in the body moves or herniates into a location that is not where it normally is. As a general surgeon, I deal with hernias of the abdominal wall. The abdominal wall is made up of layers of muscle and connective tissue that form the abdomen. So when a weakness or a hole forms in that connected tissue, that hole is the hernia. The tissues or organs underneath the hole are able to push through or herniate through the abdominal wall.

So, this is what will form the classic bulge that's associated with a hernia. Sometimes hernias will contain fat or other layers of tissue of the abdominal wall. And other times hernias can contain abdominal organs like the intestines. Hernias can develop for many reasons. Sometimes they're congenital, which means we're born with them. Others can develop over time with activity or because of other factors. Finally, some hernias are due to prior surgery.

Host: And can you tell us more about the different types of hernias and which ones are more common?

Dr. Erik DeAngeles: Yes. So, there are many different types of hernias. We name them depending upon where they develop in the body. The most common hernias that we come across are umbilical hernias, which are at the belly button and inguinal hernias, which are in the groin. Other types of hernias include femoral hernias, which are in the pelvis and incisional hernias that are at the site of prior surgical incisions.

Host: So, who is at risk for developing a hernia? Can you mention things like lifestyle factors or age?

Dr. Erik DeAngeles: So, as I mentioned, hernias can be congenital, meaning we're born with them or acquired, meaning that they develop over time. Generally speaking, anything that stretches out the abdominal wall muscles or puts increased pressure on them can cause a hernia to develop over time. This can be caused by opening up or making hernias that we are born with bigger over that period of time, or it can be due to wear and tear on the muscles and connective tissues over the years.

Some things that can cause the abdominal wall muscles to stretch or weaken to form a hernia include repetitive heavy lifting, chronic cough or constipation, being overweight as well as pregnancy. Age can also play a role as hernias can take many years to develop. And finally, people who have had surgery in the past may develop a hernia at their prior incision or incisions. This is because when tissues heal, they're never able to grow back to 100% of their strength before they were cut during a surgery.

Host: Doctor, what are the most common symptoms of a hernia?

Dr. Erik DeAngeles: So, the most common symptom of a hernia is pain or discomfort of the area. This usually will worsen with activity over the course of a day and improve with rest. There is also typically a bulge that comes in and out or increases and decreases in size over the course of a day. Over time, hernias also tend to grow in size and can become or more uncomfortable as they do so.

Host: So if we're really feeling that pain, what kind of healthcare provider should someone see if they think they have a hernia, and how are they typically diagnosed?

Dr. Erik DeAngeles: So when in doubt about your symptoms, you can always go to see your primary care doctor for a physical exam. However, you will need to see a general surgeon or a hernia specialist to have your hernia repaired. Hernias are typically diagnosed by physical exam, but imaging is often performed as well, either an ultrasound or a CT scan, depending upon the type of hernia.

Imaging helps to determine the size of the hernia as well as any other tissues or organs that may be involved, which can help to plan for a surgical repair. Sometimes people may also have a bulge without a hernia. This is called diastasis of the abdominal wall, which essentially means that there's weakness or thinning of the muscle layers, but without a hole. So since there is no hole in those cases, there's no hernia to be repaired. Diastasis can sometimes cause pain or discomfort along with a bulge. And in those cases, patients would typically need to see a plastic surgeon for treatment.

Host: And tell us what does hernia surgery involve today? How has it changed over the years?

Dr. Erik DeAngeles: I'll start by saying that all patients will have to be seen and evaluated by a surgeon prior to scheduling a hernia repair. It is important to go over all of your medical and surgical history and for the surgeon to review any imaging that's been performed as well as to perform their own exam. There may be an opportunity for patients to work with the surgeon to optimize their health prior to scheduling surgery in order for patients to be safe during surgery and to minimize their chance of complications or side effects from surgery, as well as reduce the chance that the hernia comes back again in the future. Any medical problems or risk factors should be managed prior to surgery.

So, for example, smoking and uncontrolled diabetes are associated with poor surgical outcomes as well as hernia recurrence. Patients should quit smoking and have their diabetes under control as measured by their hemoglobin A1c prior to hernia surgery. Other issues such as cough, constipation, or other medical problems like heart or lung problems should be addressed and optimized prior to surgery. This opportunity for preoperative counseling to improve outcomes after surgery may be the most important way that surgery has evolved over the years.

Now, the specific surgical technique that is used will depend upon the type of hernia being treated. However, most hernia surgery performed today is done minimally invasively using either laparoscopic or robotic techniques. Minimally invasive surgery is associated with less pain and faster recovery after surgery compared to open approaches. Most hernia surgery also involves the placement of a mesh in order to reinforce and complete the repair. Though there are some instances, for example, small umbilical hernias that may not require a mesh to be placed as part of their repair. There are also new robotic techniques that have been developed to repair larger complex hernias.

Most hernia surgery can be done as an outpatient, meaning patients come in for same-day surgery and go home from the recovery area after surgery. However, large or more complex hernias may require a stay in the hospital in order to recover.

Host: Well, that leads me into my next question. What is recovery like after hernia surgery and how long before someone can get back to their life before surgery? Things like exercise and work and normal activities.

Dr. Erik DeAngeles: So after surgery, the most common side effect is pain or discomfort. There can also be swelling or bruising around the surgical incisions or the site of the prior hernia. The exact recovery time can vary depending upon the type of hernia and its size. Usually, patients should avoid heavy lifting. Usually, we tell them nothing over 10 pounds for eight weeks after surgery.

But patients should discuss with their surgeons any activity recommendations after surgery. Patients who work in physically demanding jobs may need to take more time after work to recover than patients who have a desk job. Light activity around the house, including using stairs, is generally not limited after surgery. Walking is always encouraged as much as possible and can decrease the chance of developing a postoperative complication and help patients to recover faster after surgery.

Host: To wrap us up, Doctor, are there any ways to help prevent hernias or lower the risk of one coming back after surgery?

Dr. Erik DeAngeles: Yes. Any of the lifestyle factors that we have discussed, including quitting smoking, controlling diabetes, losing weight, avoiding constipation, and addressing chronic coughs may reduce the risk of hernias, especially a hernia coming back after surgery. Giving yourself a chance to heal after hernia surgery is also important, so follow the activity guidance of your surgeon.

Host: Well, thank you so much, Doctor. Find more shows just like this one at umms.org/podcast or over on YouTube. I'm Caitlin Whyte, and this is Live Greater, a University of Maryland Medical System podcast. Thanks for listening.