August 4, 2024 • 27 mins
08/04/24
The Healthy Matters Podcast
S03_E19 - The A-Z on Abdominal Hernias
Hernias! They're a lot more common than you think, and in fact over 20 million hernias are repaired every year! All genders and ages - from babies to the elderly - can have a hernia, so it's high time we talked about them on the show. They won't go away on their own, so it's good to know your options if you suspect you have one (or know you already do...).
On episode 19 we'll be joined by Dr. Rachel Payne, MD, a general surgeon and a specialist in hernia repair at Hennepin Healthcare. She'll walk us through the definitions, diagnosis and treatment options for these pesky protrusions. Learn about risk factors, what's happening in the body with a hernia, the different surgical approaches available (including a cool robot), and what the road to recovery is like once you're all patched up. Join us!
Got a question for the doc or a comment on the show?
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden.
Speaker 2 (00:19):
Hey everybody, it's Dr. David Hilden, and welcome
to the Healthy Matters podcast.
This is episode 19, and todaywe are gonna talk about
hernias. I'm guessing most ofyou listeners out there have
heard of hernias before, but doyou know exactly what they are
and what can be done aboutthem? Well, today we're lucky
to be joined by Dr. RachelPayne. She's a surgeon here at
(00:39):
Hennepin Healthcare, where sheis a trauma specialist, but
also she's an expert when itcomes to hernias and even
robotic surgical treatment ofhernias. I can't wait to get
into that. Rachel, welcome tothe podcast.
Speaker 3 (00:50):
Thank you for having me.
Speaker 2 (00:51):
It's great to have you here, Dr. Payne. Now first
of all, many people have heardabout hernias, and we're not
gonna talk about everythingunder the sun about hernias,
but could you just tell us whatwe mean when we say that term?
Speaker 3 (01:02):
So, for the purposes of today, we're talking about
abdominal wall hernias, whichis a subset of a very, very
broad term. Um, and looselyspeaking, we're talking about a
hole in the musculature in theabdominal wall and something
coming through that hole fromthe inside that shouldn't be
coming through it.
Speaker 2 (01:19):
So, you know, we , there's hernias all over your
body. There's you , you know ,hernias just like, like Dr.
Payne said , it's justsomething pushing through a
hole. Well, you're , you canhave herniated discs, you can
have hi AAL hernias. There'sother types. You can have
herniations in your brain, tobe honest. But we're not
talking about any of thattoday. It's about abdominal
hernias. So let's dive intothat topic. What are the most
(01:40):
common types of abdominal wallhernias?
Speaker 3 (01:42):
So the most common is an inguinal hernia or a
groin hernia. Those affect upto 25% of people who are
assigned male at birth,extremely common. Next, most
common would be a belly buttonor an umbilical hernia. And
then ventral, meaning the mainfront of the abdomen. Often
those are gonna be incisional,so they affect people who've
had previous surgery.
Speaker 2 (02:03):
I like it that there's always like a medical
term inguinal. And then there'sthe term that we just don't
like to talk about so much .
Groin. And then you talk, Ilove that belly button .
Hernia, the medical term,umbilical. So you said a very
common one, especially in thoseassigned male at birth, is
inguinal hernias. Mm-Hmm.
. What causesthat ? That,
Speaker 3 (02:21):
So there can be quite a few different causes.
One of the reasons that peoplewho are assigned male are at
higher risk is that the testesin a baby descend down into the
scrotum through an opening. Andthat opening puts people at
risk of hernias for life.
Speaker 2 (02:36):
They start out higher. Mm-Hmm.
and they descend down into thescrotum. And, and so they go,
when you say descend, they'reattached to something
obviously. Yes . You know,they're not just free floating
down there. Right . But they'reattached on this structure,
this cord does that hole notclose up or what's happening?
Speaker 3 (02:51):
The blood vessels and the nerves , um, as well as
the tube that carries sperm isactually going through that
spot. So the hole can'tcompletely close around it .
Those structures have to be
Speaker 2 (02:59):
There. And so why do we get a hernia there? And you
don't get a her , well, Isuppose you can get it when
you're younger, but I alwaysthink of it's like a little bit
older guys. Is that true?
Speaker 3 (03:07):
It's both. They're pretty common in babies too,
actually.
Speaker 2 (03:10):
Hmm . Do you do those?
Speaker 3 (03:11):
I don't. Pediatric surgeons do those. Okay.
Speaker 2 (03:13):
So why does that happen? In older men or, or
women too? Yeah , but mostly inolder men. Yeah. Yep .
Speaker 3 (03:18):
Strain on the area over time. Weakening of that
tissue, which can, there's alot of different factors to
that. Uh , people who liftheavy, especially over an
entire career, if they doreally strenuous manual labor.
Other conditions that requiremedications like steroids,
smoking and tobacco products,
Speaker 2 (03:36):
Smoking leads to worsening risk of hernia. Yep .
I think smoking's a risk foreverything.
Speaker 3 (03:41):
Pretty much everything
Speaker 2 (03:42):
Bad. I'm noting that on this podcast . We've done
this podcast for two, threeyears now, and smoking ends up
being a risk factor for thingsthat people don't think about.
Even a risk factor for hernia.
Mm-Hmm. andlifting manual labor. Mm-Hmm .
. Not justweightlifters, you're just
talking about people who liftin their jobs. Is that what
you're saying?
Speaker 3 (03:58):
Yep . People who are doing very strenuous, heavy
lifting day in and day out.
Speaker 2 (04:02):
Anything that people can do to lower your chances of
getting it? Or is this just ifyou lift things or, you know,
if you're on corticosteroids oryou smoke too much, you just
have to take your chances.
Speaker 3 (04:12):
Maintaining good core strength and staying
generally healthy, having ahealthy diet, avoiding tobacco
products. Maintain a healthyweight to the best of your
ability. People who havediabetes, keeping good blood
glucose control.
Speaker 2 (04:25):
So you're gonna tell us to like all that healthy
living stuff? Yeah . Okay . Sowe all ,
Speaker 3 (04:28):
All the same things that are good for every
condition. Yeah. It's good
Speaker 2 (04:30):
For your hearts.
Good for your hernia. So we gota surgeon telling you, you
know, also healthy livingthings . So that, but no, in
all seriousness, that makesperfect sense. That is really
good advice to start out. Weshould always exercise more to
the best. You can keep yourweight under, under control.
And I say to the best you canand as you did too, as the best
of your ability. Um, don't feelbad about yourself. Right . I
mean, you had , it's not acharacter flaw, . No,
(04:53):
absolutely not. Um , but um,that's one way to do it and
certainly , um, don't smoke.
Okay. So how would I know if Ihad an inguinal hernia? How
would, how would a person know?
The
Speaker 3 (05:03):
Most common thing is that people notice a bulge or a
lump in their groin. Sometimesit can present as a lump or a
bulge in the scrotum as well.
Does it hurt? Sometimes itdoes. You may feel a dull
aching sensation in the groinor in a belly button if it's a
belly button . Hernia.
Especially after a lot ofactivity or prolonged standing.
You ,
Speaker 2 (05:21):
You mentioned belly button hernia. So I do want to
, before I get into, like whatdo we do about it and how do
you diagnose it and all that.
We've talked about inguinalhernias in the groin or the
scrotum. What's the bellybutton hernia all about? Why do
you , you like pop through yourbelly button? Yeah . Is that
what you're saying?
Speaker 3 (05:34):
Yep . And so some people will notice a lump in
their belly button orimmediately around the belly
button or pain in the bellybutton.
Speaker 2 (05:40):
So I, I do primary care. I, I see loads of people
with hernias and loads ofpeople. Actually, they , they
do show me, you know, thislittle bulge at their belly
button or, or in their groin.
But I hear it all the time inthe belly button and then you
push it back in. So you say abulge, is it a bulge that's
always there or only whenyou're doing certain things or,
(06:01):
or is it just always there?
Like this big lump?
Speaker 3 (06:03):
It depends on the size and severity of the
hernia. Early on, most of themare gonna come and go. They can
be, as you mentioned, manuallypushed back in. You may notice
them sticking out more withmore activity or standing for
prolonged time. As hernias getmore severe. Sometimes they do
just stay stuck out and becomea permanent bulge.
Speaker 2 (06:21):
Is it dangerous?
Speaker 3 (06:22):
It can be. And especially when they get to
that point, if what'spermanently there, that bulge
is intestine or another organstuck in that hernia, that can
actually be life threatening.
Speaker 2 (06:31):
Okay. Say that again. So your intestines
sticking out the hole,
Speaker 3 (06:34):
That is one thing that can get stuck in a hernia.
I
Speaker 2 (06:36):
Mean , I kinda know some of these answers, but I
want you to say that to
Speaker 3 (06:38):
People . Yes . You can get intestines stuck in the
hernia.
Speaker 2 (06:40):
Just to get a little bit deeper into that. You've
got this bulge. Mm-Hmm.
, we all knowit's a hole in something
underneath the skin. The, the ,the connective tissues, the
musculature, the abdominalwall, the fascia, all that
stuff . But is that actuallyyour intestines pushing up
through there? Are people, isit literally someone's
intestines just protected fromthe outside by a layer of skin
at that point?
Speaker 3 (06:59):
In most cases, no.
The vast majority of hernias,the lump that you're feeling is
fat that's in there designed toprotect your organs that we all
have. But in some cases it isintestine that can be
dangerous. That's when it getsdangerous.
Speaker 2 (07:10):
Okay. So lots of people are thinking like , yeah
, I got that. I got a littlebulge coming out there . It
doesn't hurt me so much and itdoesn't bother me all that
much. It's either my bellybutton or my groin and I just
push it back in there. We'regonna talk after our break when
we get to that portion abouthow you diagnose that and what
is done about that. But beforeI get to that, how would a
(07:30):
person who's been living withthis, some people are living
with this for a long time, howwould a person know that
there's a danger here? Youknow, I don't know. I've had
this thing for two, threeyears. When, how would they
know?
Speaker 3 (07:40):
That's a very hard thing to know. And that's part
of why we say as soon as ahernia is to the point where
you can recognize that you haveit, it's time to get it looked
at by a surgeon. Mm-Hmm.
Speaker 2 (07:50):
. Okay.
Yeah. So I see people all thetime then they've got these
things forever and ever. And Iusually say, now's time, you
need to go see a surgeon now .
'cause this is not gonna getbetter all on its own . Mm-Hmm
. . So before weleave inguinal hernias, is it
on just one side or is it bothsides? Or do you often see it,
you know, literally on bothsides at the same time?
Speaker 3 (08:07):
You can see it on one or both sides. It's pretty
common for people that have oneto have one on the other side
as well.
Speaker 2 (08:13):
Wow. Okay. Now there's some other kinds that
people can get. There's somefemoral ones. And you mentioned
ventral ones. Mm-Hmm .
. Could you say alittle bit more about each of
those?
Speaker 3 (08:21):
Uh , so femoral hernias , uh, are going through
a , a hole where the bloodvessels that go to your leg are
so people feel those in thethigh. Those are much less
common than the other typeswe've talked about. Ventral
hernias can happen anywhere onthe abdominal wall. They also
are very common in peoplewho've had previous surgery at
the site of previous incisions.
(08:42):
So
Speaker 2 (08:42):
Is it the, is it because that , that's a place
of weakness in the abdominalwall? Exactly . Yep . Yeah. And
the femoral one, you said it'sdown in your thigh? Mm-Hmm.
, uh, is that, Idon't see those as much. Mm-Hmm
. . And so I'mglad you said it's a little
less common. 'cause I don't seethose quite as much. Is that
just as common? Men, women?
Those
Speaker 3 (08:58):
Are more common in women.
Speaker 2 (08:59):
Do we know why that is?
Speaker 3 (09:01):
Uh, we don't really, yeah. We especially see them
more as people age. Okay . Andwith significant weight loss,
they tend to show up.
Speaker 2 (09:06):
And so we've talked about risk factors of smoking
and lifestyle and puttingpressure on that. What about
pregnancy? You didn't mentionthat. Is that a risk for any of
these types?
Speaker 3 (09:16):
Pregnancy is a risk factor, especially for the
belly button and the ventralhernias. It's additionally a
risk for recurrence if sayyou've had one of these hernias
fixed before and then you go onto have a pregnancy,
Speaker 2 (09:27):
Because I've heard about that one a lot. There's a
ton . Speaking of pressure inthe belly. Yep . Having , uh, a
developing pregnancy. Yeah . Uh, has to be just a ton of
pressure. Okay. So now thatwe've learned a lot about all
these different types ofhernias, I think we've earned
herself a break. And I'm gonnaask Dr. Payne when we come back
to shift gears and tell us howdoes she diagnose them , uh,
when you go to see her and howshe makes the decision that
(09:49):
some surgical treatment isneeded. And then finally , all
the various types of ways thata surgeon can help you out. If
you have a hernia, stay tuned.
We'll be right back
Speaker 4 (10:00):
When he up in healthcare says, we are here
for life. They mean here foryou, your life and all that it
brings. He up in healthcare hasa hospital HCMC and a network
of clinics both downtown andacross the west metro. They
provide all the primary careand specialty care you would
expect to find. But did youknow they also have services
like acupuncture andchiropractic care available at
(10:23):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis? Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (10:38):
And we're back talking to Dr. Rachel Payne, a
surgeon at Hennepin Healthcarein downtown Minneapolis. And
we're talking about hernias. Inour first half. We talked about
the various types of them, butnow we're gonna get into how
they're diagnosed and treated.
Before we do that, I want toask you , uh, Dr. Payne , when
is it concerning? In otherwords, what signs and symptoms
would a person experience tothink that it's more of an
(11:01):
emergency?
Speaker 3 (11:02):
So if you've got a hernia that is stuck as a
permanent bulge that you can ,that you have been able to push
in and out or has gone in andout on its own and now it's
stuck, that's a concerningsign. Especially if you're, if
that's coming on with a lotworse pain , um, changes to the
skin color over the hernia. Ifyou're feeling otherwise ill
(11:24):
with that. Like you're havingfevers , uh, maybe you're
throwing up, you're not poopingor passing gas. Those are all
signs that maybe there'sintestines stuck in that hernia
and that should be evaluated
Speaker 2 (11:35):
Immediately. And there's a term for that.
Speaker 3 (11:37):
Uh , incarceration.
Speaker 2 (11:37):
Yeah, incarceration of your intestines in there.
It's stuck in there. So if youhave any of those things , uh,
listeners, please do go to anemergency department in that
case because that little pieceof bowel can get pinched off
and die off. And that's a bigdeal. Okay. In the absence of
that emergency situation, I'mglad we covered that, but in
the absence of that, let's talkabout how you diagnose it. So I
(11:59):
got this bulge, it's Cummins inand out. I can push it in
there. It's coming through mybelly button. I go to my
surgeon. What are you gonna doto a diagnose it to make sure?
And then how do you decidewhat, what, what treatments are
needed?
Speaker 3 (12:12):
So the first thing I'm going to do is examine it.
Certain hernias, that's reallyall you need , uh, to know the
diagnosis and to be ablebetween the exam and talking to
the patient and finding outwhat symptoms it's causing.
Sometimes that's all you need.
Um, if the diagnosis isn'tentirely clear or you're
worried about whether there'sintestine or other complicating
(12:32):
problems, we might do anultrasound or a CT scan,
depending on how much moreinformation we need.
Speaker 2 (12:37):
Some of them even I can do as a primary care
doctor, I can see the umbilicalhernias. I can push it and
reduce it. I can push it backin there. But some of 'em are a
little bit more subtle. Do youstill do what many, especially
men of a certain age, remember?
Mm-Hmm . like themilitary used to do this thing
. Maybe they still do. Okayguys, line up. Turn your head
to the side while I put myfinger in your groin and you're
(12:58):
gonna cough. Mm-Hmm .
. Yep . Do youstill do that?
Speaker 3 (13:00):
We do. Yep .
Speaker 2 (13:00):
We were taught that as well. What , what's the
point of all that? So
Speaker 3 (13:03):
When we're sticking our finger in that very
uncomfortable location, whatwe're actually feeling is the
external inguinal ring, whichis the opening of where the
blood vessels and the nerve andthe sperm tube go down into the
testicle. And that's the spotwhere we can feel something
herniate from inside to outsidewhen you do that bearing down
motion when you cough.
Speaker 2 (13:24):
Okay. So the cough is just to get it to kind of
push through. Mm-Hmm .
That's thepressure sensation. Yeah .
Yeah. So that is still taughtin medical schools. 'cause
it's, that's an effective wayto do it. Yep . You usually
don't need ultrasounds or otherimaging, but you can do these
in your sleep. Um, you probablyget these quite a bit. So
you're diagnosed in the clinic,there's various surgical
options. Before we get intowhat those are, is there any
(13:45):
non-surgical things that peopleconsider if they're just like,
Nope, I'm not having youoperate on me.
Speaker 3 (13:50):
There's nothing that's going to fix or reverse
a hernia short of surgery. Butin certain patients who maybe
are very, very early not havinga lot of symptoms, maybe they
have medical problems that makesurgery higher risk. Some
things that we can recommend topeople are things like
abdominal binders or herniabelts, bracing the hernia. So
holding it in when you'recoughing or straining to have a
(14:14):
bowel movement, for example.
Um, we do also recommend thatpeople try to avoid
constipation because that'sanother source of straining. So
we'll recommend fiber and stoolsofteners when necessary.
Speaker 2 (14:24):
So those are not reversing anything? No . But
they might help a little bitand maybe they're
Speaker 3 (14:28):
More symptom management.
Speaker 2 (14:29):
Maybe you should abandon your hopes of being an
Olympic weightlifter. Yes.
Okay. So that's maybe not yourbest move there. You know,
we're recording this during thesummer Olympics . So I, I'm an
Olympic fiend. I love watchingthe Olympics , but I
will not be an Olympicweightlifter, I'll tell you
that. Okay. So there's varioustypes of surgeries. I know
there's open, there'slaparoscopic, there's robotic.
(14:50):
Could you talk us us throughthose ? Start with an open
surgery. What is that?
Speaker 3 (14:54):
So open? We mean we're making a large incision
and basically using our handsand our instruments directly
to, to fix that. In the case ofa groin hernia, we're talking
about an incision that's , uh,maybe three to four inches in
the groin, kind of right overthe hernia. And we're with any
of these surgeries, we'refinding that area , that hole,
we're finding whatever's comingthrough from the inside of the
(15:15):
abdomen, putting it back whereit belongs, repairing the hole
and reinforcing that weak areawith a piece of mesh.
Speaker 2 (15:22):
Okay. So then a lot of people have heard of mesh.
In fact, some people are scaredof mesh. Yep . People hear
about, oh no, I don't wantthat. It looks like window
screen is what I kind of think.
I know it's probably some of'em do. I I I bet you don't go
down to Home Depot and buywindow screen. So what does the
mesh look
Speaker 3 (15:35):
Like? So there are hundreds of meshes on the
market. Um, the main one thatwe're using for these common
groin hernias is made ofpolypropylene. So it's a , a
plastic compound. It's reallysimilar to this material. A lot
of our sutures are made out of, um, so if you get a suture
repair, you get the samematerial. It's basically a net
made out of that material.
Speaker 2 (15:55):
Is , is it, is it stiff? Is it like, or could you
crumple it up in a ball? Is itlike real, like flexible? It's
Speaker 3 (16:01):
Flexible because it's made as kind of like a net
or a fence . If it were fullysolid, it would be less
flexible.
Speaker 2 (16:08):
Hmm . So do you just put sutures then through the
holes in the side of it? Isthat what you do? You can just
cut it to size and, and thatgoes into the tissue then?
Speaker 3 (16:16):
Yep . We cut it to size to fit the area that we
need to repair and reinforce.
And we use sutures to gothrough the edge of the mesh
and through the patient'stissue. So
Speaker 2 (16:25):
Why are people worried about it? So there ,
maybe that's speculation, butwhat , I guess what , what
could go wrong? I guess
Speaker 3 (16:29):
It's definitely not speculation. It's a question we
hear a lot in our clinics.
Mm-Hmm . .
Anytime we put somethingforeign in the body, there are
risks. Uh, infection is acommon one. Mesh eroding
through tissue into otherstructures. If it gets into the
abdomen, gets into intestines,that can be a really big
problem. Thankfully that'sextremely rare. Mm-Hmm .
a lot of the, youknow, if people are seeing
(16:50):
hernia lawsuits on tv, thoseare usually more advanced
complex meshes designed forthese really serious abdominal
wall reconstructions. Those arevery different than the types
of mesh that we're usuallyputting in a standard groin
hernia or umbilical hernia.
Speaker 2 (17:06):
So the complications are not that common. But
they're, they're rare. They'rethey're rare. They're not,
Speaker 3 (17:11):
They're narrow but they , they're rare not ,
Speaker 2 (17:12):
Yeah . Okay. 'cause people do hear about that.
That's the kind of thing thatis out there quite a bit.
Mm-Hmm. . And itshould be noted at the vast
majority of people we'retalking millions of people Yep
. Are walking around with meshand forgot they have it.
Speaker 3 (17:22):
Yes. Over 20 million hernias are repaired in the US
every year.
Speaker 2 (17:25):
Every year. Oh my goodness. I was gonna say, is
that like a cumulative thingevery year? 20 million hernias.
And so you hear about a fewthat went , yeah , the , the
rare that the complicationsthat the vast majority of those
20 million are doing just fine.
So that's an open surgery. Youput a little mesh in there, you
sew it all up, you put the skinover the top of it and they go
about their business. Whatabout, what's laparoscopic
then?
Speaker 3 (17:45):
So laparoscopic, we're making a few very small
incisions about half acentimeter and then putting in
a camera and long thininstruments. So we're operating
from the outside using a camerapicture to see what we're doing
on the inside. It
Speaker 2 (17:59):
Seems like if this hole is right at the surface,
there's not a lot of inside tolook at, isn't it kind of right
there under the surface.
Speaker 3 (18:05):
So not always. It depends a little bit on every
individual's anatomy. When wedo the procedural
laparoscopically, another bigbenefit is that we can evaluate
both sides from the same at thesame time. So if say you have a
hernia in both groins, we cansee them and fix them in one
surgery. Uh, there's also a lotless pain associated with that
surgery. We're looking at thesame hole in the same tissues.
(18:26):
Just from the inside instead offrom the outside.
Speaker 2 (18:28):
Okay. Okay. And you still put mesh in there? Mm-Hmm
. and the , likehow many are, are , are these
equally common or or is itmostly surgeon preference or is
it just patient preference? Howdo you decide which way to go?
They're
Speaker 3 (18:40):
Both still very common. It's increasingly
laparoscopic and minimallyinvasive techniques are more
common. But there's surgeonpreference and skill plays a
role. Patient preference playsa role. Certainly one of the
benefits to open hernias isthat they can help you reduce
very stuck or difficult herniasmore easily. Especially if
(19:01):
there's things like a lot ofintestine in them. Um,
sometimes we just can't safelydo that laparoscopically you
Speaker 2 (19:07):
'cause you're just looking at it directly. Yeah .
You've just got a view.
Speaker 3 (19:09):
Yeah. And you have to kind of pull on the
intestine from the inside attimes in ways that you might
damage it. And if you'relooking at from the outside,
you can more safely managethat. If you've had a prior
hernia repair and then you havea recurrence, whatever type of
repair you already had, thosetissue planes are violated from
the previous surgery and it'sreally hard to do the same
surgery you already had. Sousually we'll choose a
(19:31):
different approach than whatyou had the last time.
Speaker 2 (19:32):
Oh that's interesting.
Speaker 3 (19:33):
If you people that have really serious medical
problems where they may be arisk for being fully asleep
under general anesthesia, theopen repairs we can actually do
under what's called mac. Soit's heavy sedation. You're not
aware of what's going on, butyou're still breathing on your
own and you don't have abreathing tube in and you're
not paralyzed with drugs forthe surgery. And so that can
allow us to fix hernias inpeople that have medical
(19:55):
problems that would make itunsafe to put them all the way
to sleep.
Speaker 2 (19:57):
So you're one of the surgeons at this hospital and
many hospitals now around thecountry that use a robot?
Mm-Hmm. . That'scool as heck. , but
most people have no idea whatthat means. Yeah . What do you
mean you bring in a littlerobot? You know, that comes
wheeling in what? Explainrobotic surgery.
Speaker 3 (20:13):
So robotic surgery is upgraded laparoscopic
surgery. Basically it's stillsmall incisions where we're
using a camera and longinstruments that were operating
from the outside. Thedifference is that the robot
and the robotic instruments letus function with those small
instruments on the inside. Muchmore like our hands function
when we're doing open surgery,they, you know, they rotate a
(20:35):
full 360 degrees. The robotalso has a 3D camera and so we
can see a lot better than wecan with a traditional 2D
laparoscopic camera. Butoverall the procedure's gonna
be very similar to laparoscopicin terms of what we do and you
know , what the incisions arelike. It just gives us a lot
more flexibility with whatsorts of things we can do
through small incisions.
Speaker 2 (20:54):
How commonly do you use the robot on hernias? I
know there's other indications,right ? Not just hernias, but
do you use it very often forhernias? Uh,
Speaker 3 (21:01):
It's my preferred approach for hernias and part
of that is because I, I do havethat really good visualization
with a good camera. I have theinstruments that can articulate
and do basically the samethings as my own hands can do
when I'm open. So it
Speaker 2 (21:14):
Simulates your hands. That's
Speaker 3 (21:16):
Interesting. Yeah , the laparoscopic instruments
are basically sticks. You cankind of move up and down and
back and forth, but you're ,you're fairly limited in some
of those more finer motions.
The robot allows us to sort ofreplicate open surgery through
a small incision. That's
Speaker 2 (21:29):
Super cool. So you're sitting in the room?
Mm-Hmm. rightnext to the patient. Yeah .
Right next to the robot. Yes .
Looking on the screen. That'sall very high tech .
Speaker 3 (21:37):
Yes. And the robot can do nothing independently of
a surgeon operating it. Yeah .
You're
Speaker 2 (21:41):
Not sitting at home with a cotton . Yeah . Like,
you know, eating bon bonds .
Right . And you know, and andyeah. Have the robot do that
surgery. Right . You're rightthere operating it. Yeah .
Speaker 3 (21:50):
Yep . I'm three feet from the patient.
Speaker 2 (21:52):
Somebody actually asked me that. Mm-Hmm . They
said what ? What does somerobot come wheel ? They're
thinking of something like fromthe Jetsons or something, you
know , something comes wheelsin and has a face. Mm-Hmm . And
everything. That's not it. No .
You are sitting there with thisextraordinarily advanced piece
of technology and you'resitting right next to it
operating it. Yep . Let's talkabout what patients can expect
who are anticipating a herniasurgery and then what they can
(22:12):
expect for recovery. Before Ilet you go here, how do you
tell patients to prepareanything they have to know
getting ready for theirsurgery?
Speaker 3 (22:20):
Uh , the biggest thing I would say is healthy
habits. The more fit you aregoing into surgery, the better
you're gonna recover.
Nutritious diet, high nutrientsand especially protein is gonna
help you recover from surgery.
If they're using tobaccoproducts of any kind, I
encourage quitting in order toreduce wound complications and
if they happen to havediabetes, controlling blood
sugar well before surgery.
Speaker 2 (22:41):
Okay. So that's what you do ahead of time. You get
your surgery done at your localcenter. What can someone expect
in recovery from all three ofthose types? Robot,
laparoscopic or an opensurgery? Yeah,
Speaker 3 (22:53):
So pain for any of them, the pain is gonna be
worse. The first 72 hours iswhen you're gonna have the most
pain after surgery. Um, theopen is gonna have the most
pain of the three. The roboticand laparoscopic are gonna be
similar to each other. They'regonna have less pain.
Speaker 2 (23:06):
Is that just 'cause the incisions are smaller?
Speaker 3 (23:08):
Yeah. And then after that first 72 hours, you're
gonna start to feel a littlebit better. Every day you're
gonna be sore, noticeably sorefor a cup for about two weeks.
And then I usually tell peopleby four to six weeks is when
they're kind of at that pointwhere they don't really notice
it anymore. In between the twoweek point and that point
you're still gradually gettingbetter every day. You're kind
of still feeling twinges whenyou move around. But the really
(23:31):
the serious, you know, takingit easy recovery is more the
first couple weeks.
Speaker 2 (23:35):
So do you tell people to lay off your
activities or don't go to workor particularly if you're doing
lifting and things, I wouldimagine
Speaker 3 (23:42):
Yeah, we tell 'em to avoid strenuous activity, but
walking is really, really goodfor people after any kind of
surgery and certainly herniasurgery. So we encourage people
to treat recovering fromsurgery like it's their job and
say okay, I need to go on saythree walks every day and in
between otherwise getting alittle extra rest, making sure
they're getting good nutrition.
It seems
Speaker 2 (24:02):
Like that's always the case in patients. So I say
these surgeons are ruthless.
They say you gotta go walk anddo things. I just wanna sit on
the couch. That's not the rightplan, huh?
Speaker 3 (24:10):
No, unfortunately you recover faster if you walk
more. And the other thing wenotice is that our patients who
walk more after surgery andwalk sooner after surgery
report less pain sooner. Thosefirst few times of getting up
are definitely sore, but themore you do it, the faster that
it gets easier and the betteryou recover.
Speaker 2 (24:29):
Really good tips.
That's good Tips for a speedyand a healthy recovery. Okay.
So before we get away from theactual surgical technique,
'cause this is fascinating, notonly to me, but I bet a lot of
people, some people come out oftheir hernia surgery, they have
one little, you know, threeinch long incision and then
other people have re reportedsurprised that they have three
incisions, although they'resmaller and I think it's
(24:50):
obviously related to thetechnique used . Why three
incisions versus the one? Couldyou explain that?
Speaker 3 (24:55):
Yeah, so through either the laparoscopic or the
robotic techniques, we're usingbasically a very small incision
for each instrument. And sotypically there are three of
them. We have a camera and thenwe have two hands versus the
open. It's gonna be just theone bigger incision that's big
enough for us to get our handsin there and repair this
directly.
Speaker 2 (25:12):
Okay. So when, so if you came outta your hernia
surgery listeners and you hadthree little small incisions,
don't worry they didn't trythree times, right ? It was
three different , threedifferent instruments that went
into your belly. I have oneother question. How likely are
they to recur? In other words,once you get this fixed, are
you good for life and if theydo recur, is it at the same
(25:32):
place or, or , or somewhereelse? Could you say something
about that?
Speaker 3 (25:36):
Yeah, so different hernias have different
recurrence risks. Um , theinguinal groin hernias that
we've been talking a lot about,the recurrence rate for that is
around 5%. So it's about one in20 of them will will come back
even after surgery. And that'swith mesh. That rate is much
higher if we didn't use mesh.
That's why we do use mesh sooften. So
Speaker 2 (25:52):
5% in the first year or you mean 5% for lifetime in
your life? You got a one in 20chance? Mm-Hmm it
might come back,
Speaker 3 (25:59):
Right? Recurrence is most common within the first
three years, but it's a risk.
Anytime ventral hernias andlarger hernias, especially
those that are already from asurgical incision have a much
higher risk of recurrence.
Speaker 2 (26:12):
Okay. Is that because the mesh failed or it's
around the mesh or , or whywould they recur? Those
Speaker 3 (26:19):
Locations are an area of higher pressure. So
just everything that you do allday is putting more tension on
that main part of your abdomenthan it is on the groin. Also,
those are areas that werealready weakened by a prior
surgery and we reinforce withmesh, we repair that tissue,
but nothing brings back thattissue strength once it's been
reduced.
Speaker 2 (26:37):
Yeah, that makes sense. That really makes sense.
Well, Rachel, thank you fortalking with us about hernias
today. We've been talking withDr. Rachel Payne. She is a
surgeon here at HennepinHealthcare in downtown
Minneapolis. We've been talkingabout abdominal wall hernias,
so lots of information on thisshow that applies to so many of
our listeners. So I want tothank you for being on the show
today.
Speaker 1 (26:56):
Thanks for having me.
Speaker 2 (26:57):
I've learned a ton about hernias and I hope you
have as well listeners. Ournext episode will drop in two
weeks and I hope you'll join usfor that one. In the meantime,
be healthy and be well.
Speaker 1 (27:09):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(27:31):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At Highball Executiveproducers are Jonathan , CTO
and Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(27:52):
time, be healthy and be well.
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden.
Speaker 2 (00:19):
Hey everybody, it's Dr. David Hilden, and welcome
to the Healthy Matters podcast.
This is episode 19, and todaywe are gonna talk about
hernias. I'm guessing most ofyou listeners out there have
heard of hernias before, but doyou know exactly what they are
and what can be done aboutthem? Well, today we're lucky
to be joined by Dr. RachelPayne. She's a surgeon here at
(00:39):
Hennepin Healthcare, where sheis a trauma specialist, but
also she's an expert when itcomes to hernias and even
robotic surgical treatment ofhernias. I can't wait to get
into that. Rachel, welcome tothe podcast.
Speaker 3 (00:50):
Thank you for having me.
Speaker 2 (00:51):
It's great to have you here, Dr. Payne. Now first
of all, many people have heardabout hernias, and we're not
gonna talk about everythingunder the sun about hernias,
but could you just tell us whatwe mean when we say that term?
Speaker 3 (01:02):
So, for the purposes of today, we're talking about
abdominal wall hernias, whichis a subset of a very, very
broad term. Um, and looselyspeaking, we're talking about a
hole in the musculature in theabdominal wall and something
coming through that hole fromthe inside that shouldn't be
coming through it.
Speaker 2 (01:19):
So, you know, we , there's hernias all over your
body. There's you , you know ,hernias just like, like Dr.
Payne said , it's justsomething pushing through a
hole. Well, you're , you canhave herniated discs, you can
have hi AAL hernias. There'sother types. You can have
herniations in your brain, tobe honest. But we're not
talking about any of thattoday. It's about abdominal
hernias. So let's dive intothat topic. What are the most
(01:40):
common types of abdominal wallhernias?
Speaker 3 (01:42):
So the most common is an inguinal hernia or a
groin hernia. Those affect upto 25% of people who are
assigned male at birth,extremely common. Next, most
common would be a belly buttonor an umbilical hernia. And
then ventral, meaning the mainfront of the abdomen. Often
those are gonna be incisional,so they affect people who've
had previous surgery.
Speaker 2 (02:03):
I like it that there's always like a medical
term inguinal. And then there'sthe term that we just don't
like to talk about so much .
Groin. And then you talk, Ilove that belly button .
Hernia, the medical term,umbilical. So you said a very
common one, especially in thoseassigned male at birth, is
inguinal hernias. Mm-Hmm.
Speaker 3 (02:21):
So there can be quite a few different causes.
One of the reasons that peoplewho are assigned male are at
higher risk is that the testesin a baby descend down into the
scrotum through an opening. Andthat opening puts people at
risk of hernias for life.
Speaker 2 (02:36):
They start out higher. Mm-Hmm.
and they descend down into thescrotum. And, and so they go,
when you say descend, they'reattached to something
obviously. Yes . You know,they're not just free floating
down there. Right . But they'reattached on this structure,
this cord does that hole notclose up or what's happening?
Speaker 3 (02:51):
The blood vessels and the nerves , um, as well as
the tube that carries sperm isactually going through that
spot. So the hole can'tcompletely close around it .
Those structures have to be
Speaker 2 (02:59):
There. And so why do we get a hernia there? And you
don't get a her , well, Isuppose you can get it when
you're younger, but I alwaysthink of it's like a little bit
older guys. Is that true?
Speaker 3 (03:07):
It's both. They're pretty common in babies too,
actually.
Speaker 2 (03:10):
Hmm . Do you do those?
Speaker 3 (03:11):
I don't. Pediatric surgeons do those. Okay.
Speaker 2 (03:13):
So why does that happen? In older men or, or
women too? Yeah , but mostly inolder men. Yeah. Yep .
Speaker 3 (03:18):
Strain on the area over time. Weakening of that
tissue, which can, there's alot of different factors to
that. Uh , people who liftheavy, especially over an
entire career, if they doreally strenuous manual labor.
Other conditions that requiremedications like steroids,
smoking and tobacco products,
Speaker 2 (03:36):
Smoking leads to worsening risk of hernia. Yep .
I think smoking's a risk foreverything.
Speaker 3 (03:41):
Pretty much everything
Speaker 2 (03:42):
Bad. I'm noting that on this podcast . We've done
this podcast for two, threeyears now, and smoking ends up
being a risk factor for thingsthat people don't think about.
Even a risk factor for hernia.
Mm-Hmm.
talking about people who liftin their jobs. Is that what
you're saying?
Speaker 3 (03:58):
Yep . People who are doing very strenuous, heavy
lifting day in and day out.
Speaker 2 (04:02):
Anything that people can do to lower your chances of
getting it? Or is this just ifyou lift things or, you know,
if you're on corticosteroids oryou smoke too much, you just
have to take your chances.
Speaker 3 (04:12):
Maintaining good core strength and staying
generally healthy, having ahealthy diet, avoiding tobacco
products. Maintain a healthyweight to the best of your
ability. People who havediabetes, keeping good blood
glucose control.
Speaker 2 (04:25):
So you're gonna tell us to like all that healthy
living stuff? Yeah . Okay . Sowe all ,
Speaker 3 (04:28):
All the same things that are good for every
condition. Yeah. It's good
Speaker 2 (04:30):
For your hearts.
Good for your hernia. So we gota surgeon telling you, you
know, also healthy livingthings . So that, but no, in
all seriousness, that makesperfect sense. That is really
good advice to start out. Weshould always exercise more to
the best. You can keep yourweight under, under control.
And I say to the best you canand as you did too, as the best
of your ability. Um, don't feelbad about yourself. Right . I
mean, you had , it's not acharacter flaw,
(04:53):
absolutely not. Um , but um,that's one way to do it and
certainly , um, don't smoke.
Okay. So how would I know if Ihad an inguinal hernia? How
would, how would a person know?
The
Speaker 3 (05:03):
Most common thing is that people notice a bulge or a
lump in their groin. Sometimesit can present as a lump or a
bulge in the scrotum as well.
Does it hurt? Sometimes itdoes. You may feel a dull
aching sensation in the groinor in a belly button if it's a
belly button . Hernia.
Especially after a lot ofactivity or prolonged standing.
You ,
Speaker 2 (05:21):
You mentioned belly button hernia. So I do want to
, before I get into, like whatdo we do about it and how do
you diagnose it and all that.
We've talked about inguinalhernias in the groin or the
scrotum. What's the bellybutton hernia all about? Why do
you , you like pop through yourbelly button? Yeah . Is that
what you're saying?
Speaker 3 (05:34):
Yep . And so some people will notice a lump in
their belly button orimmediately around the belly
button or pain in the bellybutton.
Speaker 2 (05:40):
So I, I do primary care. I, I see loads of people
with hernias and loads ofpeople. Actually, they , they
do show me, you know, thislittle bulge at their belly
button or, or in their groin.
But I hear it all the time inthe belly button and then you
push it back in. So you say abulge, is it a bulge that's
always there or only whenyou're doing certain things or,
(06:01):
or is it just always there?
Like this big lump?
Speaker 3 (06:03):
It depends on the size and severity of the
hernia. Early on, most of themare gonna come and go. They can
be, as you mentioned, manuallypushed back in. You may notice
them sticking out more withmore activity or standing for
prolonged time. As hernias getmore severe. Sometimes they do
just stay stuck out and becomea permanent bulge.
Speaker 2 (06:21):
Is it dangerous?
Speaker 3 (06:22):
It can be. And especially when they get to
that point, if what'spermanently there, that bulge
is intestine or another organstuck in that hernia, that can
actually be life threatening.
Speaker 2 (06:31):
Okay. Say that again. So your intestines
sticking out the hole,
Speaker 3 (06:34):
That is one thing that can get stuck in a hernia.
I
Speaker 2 (06:36):
Mean , I kinda know some of these answers, but I
want you to say that to
Speaker 3 (06:38):
People . Yes . You can get intestines stuck in the
hernia.
Speaker 2 (06:40):
Just to get a little bit deeper into that. You've
got this bulge. Mm-Hmm.
underneath the skin. The, the ,the connective tissues, the
musculature, the abdominalwall, the fascia, all that
stuff . But is that actuallyyour intestines pushing up
through there? Are people, isit literally someone's
intestines just protected fromthe outside by a layer of skin
at that point?
Speaker 3 (06:59):
In most cases, no.
The vast majority of hernias,the lump that you're feeling is
fat that's in there designed toprotect your organs that we all
have. But in some cases it isintestine that can be
dangerous. That's when it getsdangerous.
Speaker 2 (07:10):
Okay. So lots of people are thinking like , yeah
, I got that. I got a littlebulge coming out there . It
doesn't hurt me so much and itdoesn't bother me all that
much. It's either my bellybutton or my groin and I just
push it back in there. We'regonna talk after our break when
we get to that portion abouthow you diagnose that and what
is done about that. But beforeI get to that, how would a
(07:30):
person who's been living withthis, some people are living
with this for a long time, howwould a person know that
there's a danger here? Youknow, I don't know. I've had
this thing for two, threeyears. When, how would they
know?
Speaker 3 (07:40):
That's a very hard thing to know. And that's part
of why we say as soon as ahernia is to the point where
you can recognize that you haveit, it's time to get it looked
at by a surgeon. Mm-Hmm.
Speaker 2 (07:50):
Yeah. So I see people all thetime then they've got these
things forever and ever. And Iusually say, now's time, you
need to go see a surgeon now .
'cause this is not gonna getbetter all on its own . Mm-Hmm
.
on just one side or is it bothsides? Or do you often see it,
you know, literally on bothsides at the same time?
Speaker 3 (08:07):
You can see it on one or both sides. It's pretty
common for people that have oneto have one on the other side
as well.
Speaker 2 (08:13):
Wow. Okay. Now there's some other kinds that
people can get. There's somefemoral ones. And you mentioned
ventral ones. Mm-Hmm .
those?
Speaker 3 (08:21):
Uh , so femoral hernias , uh, are going through
a , a hole where the bloodvessels that go to your leg are
so people feel those in thethigh. Those are much less
common than the other typeswe've talked about. Ventral
hernias can happen anywhere onthe abdominal wall. They also
are very common in peoplewho've had previous surgery at
the site of previous incisions.
(08:42):
So
Speaker 2 (08:42):
Is it the, is it because that , that's a place
of weakness in the abdominalwall? Exactly . Yep . Yeah. And
the femoral one, you said it'sdown in your thigh? Mm-Hmm.
.
less common. 'cause I don't seethose quite as much. Is that
just as common? Men, women?
Those
Speaker 3 (08:58):
Are more common in women.
Speaker 2 (08:59):
Do we know why that is?
Speaker 3 (09:01):
Uh, we don't really, yeah. We especially see them
more as people age. Okay . Andwith significant weight loss,
they tend to show up.
Speaker 2 (09:06):
And so we've talked about risk factors of smoking
and lifestyle and puttingpressure on that. What about
pregnancy? You didn't mentionthat. Is that a risk for any of
these types?
Speaker 3 (09:16):
Pregnancy is a risk factor, especially for the
belly button and the ventralhernias. It's additionally a
risk for recurrence if sayyou've had one of these hernias
fixed before and then you go onto have a pregnancy,
Speaker 2 (09:27):
Because I've heard about that one a lot. There's a
ton . Speaking of pressure inthe belly. Yep . Having , uh, a
developing pregnancy. Yeah . Uh, has to be just a ton of
pressure. Okay. So now thatwe've learned a lot about all
these different types ofhernias, I think we've earned
herself a break. And I'm gonnaask Dr. Payne when we come back
to shift gears and tell us howdoes she diagnose them , uh,
when you go to see her and howshe makes the decision that
(09:49):
some surgical treatment isneeded. And then finally , all
the various types of ways thata surgeon can help you out. If
you have a hernia, stay tuned.
We'll be right back
Speaker 4 (10:00):
When he up in healthcare says, we are here
for life. They mean here foryou, your life and all that it
brings. He up in healthcare hasa hospital HCMC and a network
of clinics both downtown andacross the west metro. They
provide all the primary careand specialty care you would
expect to find. But did youknow they also have services
like acupuncture andchiropractic care available at
(10:23):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis? Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (10:38):
And we're back talking to Dr. Rachel Payne, a
surgeon at Hennepin Healthcarein downtown Minneapolis. And
we're talking about hernias. Inour first half. We talked about
the various types of them, butnow we're gonna get into how
they're diagnosed and treated.
Before we do that, I want toask you , uh, Dr. Payne , when
is it concerning? In otherwords, what signs and symptoms
would a person experience tothink that it's more of an
(11:01):
emergency?
Speaker 3 (11:02):
So if you've got a hernia that is stuck as a
permanent bulge that you can ,that you have been able to push
in and out or has gone in andout on its own and now it's
stuck, that's a concerningsign. Especially if you're, if
that's coming on with a lotworse pain , um, changes to the
skin color over the hernia. Ifyou're feeling otherwise ill
(11:24):
with that. Like you're havingfevers , uh, maybe you're
throwing up, you're not poopingor passing gas. Those are all
signs that maybe there'sintestines stuck in that hernia
and that should be evaluated
Speaker 2 (11:35):
Immediately. And there's a term for that.
Speaker 3 (11:37):
Uh , incarceration.
Speaker 2 (11:37):
Yeah, incarceration of your intestines in there.
It's stuck in there. So if youhave any of those things , uh,
listeners, please do go to anemergency department in that
case because that little pieceof bowel can get pinched off
and die off. And that's a bigdeal. Okay. In the absence of
that emergency situation, I'mglad we covered that, but in
the absence of that, let's talkabout how you diagnose it. So I
(11:59):
got this bulge, it's Cummins inand out. I can push it in
there. It's coming through mybelly button. I go to my
surgeon. What are you gonna doto a diagnose it to make sure?
And then how do you decidewhat, what, what treatments are
needed?
Speaker 3 (12:12):
So the first thing I'm going to do is examine it.
Certain hernias, that's reallyall you need , uh, to know the
diagnosis and to be ablebetween the exam and talking to
the patient and finding outwhat symptoms it's causing.
Sometimes that's all you need.
Um, if the diagnosis isn'tentirely clear or you're
worried about whether there'sintestine or other complicating
(12:32):
problems, we might do anultrasound or a CT scan,
depending on how much moreinformation we need.
Speaker 2 (12:37):
Some of them even I can do as a primary care
doctor, I can see the umbilicalhernias. I can push it and
reduce it. I can push it backin there. But some of 'em are a
little bit more subtle. Do youstill do what many, especially
men of a certain age, remember?
Mm-Hmm .
. Maybe they still do. Okayguys, line up. Turn your head
to the side while I put myfinger in your groin and you're
(12:58):
gonna cough. Mm-Hmm .
Speaker 3 (13:00):
We do. Yep .
Speaker 2 (13:00):
We were taught that as well. What , what's the
point of all that? So
Speaker 3 (13:03):
When we're sticking our finger in that very
uncomfortable location, whatwe're actually feeling is the
external inguinal ring, whichis the opening of where the
blood vessels and the nerve andthe sperm tube go down into the
testicle. And that's the spotwhere we can feel something
herniate from inside to outsidewhen you do that bearing down
motion when you cough.
Speaker 2 (13:24):
Okay. So the cough is just to get it to kind of
push through. Mm-Hmm .
Yeah. So that is still taughtin medical schools. 'cause
it's, that's an effective wayto do it. Yep . You usually
don't need ultrasounds or otherimaging, but you can do these
in your sleep. Um, you probablyget these quite a bit. So
you're diagnosed in the clinic,there's various surgical
options. Before we get intowhat those are, is there any
(13:45):
non-surgical things that peopleconsider if they're just like,
Nope, I'm not having youoperate on me.
Speaker 3 (13:50):
There's nothing that's going to fix or reverse
a hernia short of surgery. Butin certain patients who maybe
are very, very early not havinga lot of symptoms, maybe they
have medical problems that makesurgery higher risk. Some
things that we can recommend topeople are things like
abdominal binders or herniabelts, bracing the hernia. So
holding it in when you'recoughing or straining to have a
(14:14):
bowel movement, for example.
Um, we do also recommend thatpeople try to avoid
constipation because that'sanother source of straining. So
we'll recommend fiber and stoolsofteners when necessary.
Speaker 2 (14:24):
So those are not reversing anything? No . But
they might help a little bitand maybe they're
Speaker 3 (14:28):
More symptom management.
Speaker 2 (14:29):
Maybe you should abandon your hopes of being an
Olympic weightlifter. Yes.
Okay. So that's maybe not yourbest move there. You know,
we're recording this during thesummer Olympics . So I, I'm an
Olympic fiend. I love watchingthe Olympics
will not be an Olympicweightlifter, I'll tell you
that. Okay. So there's varioustypes of surgeries. I know
there's open, there'slaparoscopic, there's robotic.
(14:50):
Could you talk us us throughthose ? Start with an open
surgery. What is that?
Speaker 3 (14:54):
So open? We mean we're making a large incision
and basically using our handsand our instruments directly
to, to fix that. In the case ofa groin hernia, we're talking
about an incision that's , uh,maybe three to four inches in
the groin, kind of right overthe hernia. And we're with any
of these surgeries, we'refinding that area , that hole,
we're finding whatever's comingthrough from the inside of the
(15:15):
abdomen, putting it back whereit belongs, repairing the hole
and reinforcing that weak areawith a piece of mesh.
Speaker 2 (15:22):
Okay. So then a lot of people have heard of mesh.
In fact, some people are scaredof mesh. Yep . People hear
about, oh no, I don't wantthat. It looks like window
screen is what I kind of think.
I know it's probably some of'em do. I I I bet you don't go
down to Home Depot and buywindow screen. So what does the
mesh look
Speaker 3 (15:35):
Like? So there are hundreds of meshes on the
market. Um, the main one thatwe're using for these common
groin hernias is made ofpolypropylene. So it's a , a
plastic compound. It's reallysimilar to this material. A lot
of our sutures are made out of, um, so if you get a suture
repair, you get the samematerial. It's basically a net
made out of that material.
Speaker 2 (15:55):
Is , is it, is it stiff? Is it like, or could you
crumple it up in a ball? Is itlike real, like flexible? It's
Speaker 3 (16:01):
Flexible because it's made as kind of like a net
or a fence . If it were fullysolid, it would be less
flexible.
Speaker 2 (16:08):
Hmm . So do you just put sutures then through the
holes in the side of it? Isthat what you do? You can just
cut it to size and, and thatgoes into the tissue then?
Speaker 3 (16:16):
Yep . We cut it to size to fit the area that we
need to repair and reinforce.
And we use sutures to gothrough the edge of the mesh
and through the patient'stissue. So
Speaker 2 (16:25):
Why are people worried about it? So there ,
maybe that's speculation, butwhat , I guess what , what
could go wrong? I guess
Speaker 3 (16:29):
It's definitely not speculation. It's a question we
hear a lot in our clinics.
Mm-Hmm .
Anytime we put somethingforeign in the body, there are
risks. Uh, infection is acommon one. Mesh eroding
through tissue into otherstructures. If it gets into the
abdomen, gets into intestines,that can be a really big
problem. Thankfully that'sextremely rare. Mm-Hmm .
(16:50):
hernia lawsuits on tv, thoseare usually more advanced
complex meshes designed forthese really serious abdominal
wall reconstructions. Those arevery different than the types
of mesh that we're usuallyputting in a standard groin
hernia or umbilical hernia.
Speaker 2 (17:06):
So the complications are not that common. But
they're, they're rare. They'rethey're rare. They're not,
Speaker 3 (17:11):
They're narrow but they , they're rare not ,
Speaker 2 (17:12):
Yeah . Okay. 'cause people do hear about that.
That's the kind of thing thatis out there quite a bit.
Mm-Hmm.
majority of people we'retalking millions of people Yep
. Are walking around with meshand forgot they have it.
Speaker 3 (17:22):
Yes. Over 20 million hernias are repaired in the US
every year.
Speaker 2 (17:25):
Every year. Oh my goodness. I was gonna say, is
that like a cumulative thingevery year? 20 million hernias.
And so you hear about a fewthat went , yeah , the , the
rare that the complicationsthat the vast majority of those
20 million are doing just fine.
So that's an open surgery. Youput a little mesh in there, you
sew it all up, you put the skinover the top of it and they go
about their business. Whatabout, what's laparoscopic
then?
Speaker 3 (17:45):
So laparoscopic, we're making a few very small
incisions about half acentimeter and then putting in
a camera and long thininstruments. So we're operating
from the outside using a camerapicture to see what we're doing
on the inside. It
Speaker 2 (17:59):
Seems like if this hole is right at the surface,
there's not a lot of inside tolook at, isn't it kind of right
there under the surface.
Speaker 3 (18:05):
So not always. It depends a little bit on every
individual's anatomy. When wedo the procedural
laparoscopically, another bigbenefit is that we can evaluate
both sides from the same at thesame time. So if say you have a
hernia in both groins, we cansee them and fix them in one
surgery. Uh, there's also a lotless pain associated with that
surgery. We're looking at thesame hole in the same tissues.
(18:26):
Just from the inside instead offrom the outside.
Speaker 2 (18:28):
Okay. Okay. And you still put mesh in there? Mm-Hmm
.
equally common or or is itmostly surgeon preference or is
it just patient preference? Howdo you decide which way to go?
They're
Speaker 3 (18:40):
Both still very common. It's increasingly
laparoscopic and minimallyinvasive techniques are more
common. But there's surgeonpreference and skill plays a
role. Patient preference playsa role. Certainly one of the
benefits to open hernias isthat they can help you reduce
very stuck or difficult herniasmore easily. Especially if
(19:01):
there's things like a lot ofintestine in them. Um,
sometimes we just can't safelydo that laparoscopically you
Speaker 2 (19:07):
'cause you're just looking at it directly. Yeah .
You've just got a view.
Speaker 3 (19:09):
Yeah. And you have to kind of pull on the
intestine from the inside attimes in ways that you might
damage it. And if you'relooking at from the outside,
you can more safely managethat. If you've had a prior
hernia repair and then you havea recurrence, whatever type of
repair you already had, thosetissue planes are violated from
the previous surgery and it'sreally hard to do the same
surgery you already had. Sousually we'll choose a
(19:31):
different approach than whatyou had the last time.
Speaker 2 (19:32):
Oh that's interesting.
Speaker 3 (19:33):
If you people that have really serious medical
problems where they may be arisk for being fully asleep
under general anesthesia, theopen repairs we can actually do
under what's called mac. Soit's heavy sedation. You're not
aware of what's going on, butyou're still breathing on your
own and you don't have abreathing tube in and you're
not paralyzed with drugs forthe surgery. And so that can
allow us to fix hernias inpeople that have medical
(19:55):
problems that would make itunsafe to put them all the way
to sleep.
Speaker 2 (19:57):
So you're one of the surgeons at this hospital and
many hospitals now around thecountry that use a robot?
Mm-Hmm.
most people have no idea whatthat means. Yeah . What do you
mean you bring in a littlerobot? You know, that comes
wheeling in what? Explainrobotic surgery.
Speaker 3 (20:13):
So robotic surgery is upgraded laparoscopic
surgery. Basically it's stillsmall incisions where we're
using a camera and longinstruments that were operating
from the outside. Thedifference is that the robot
and the robotic instruments letus function with those small
instruments on the inside. Muchmore like our hands function
when we're doing open surgery,they, you know, they rotate a
(20:35):
full 360 degrees. The robotalso has a 3D camera and so we
can see a lot better than wecan with a traditional 2D
laparoscopic camera. Butoverall the procedure's gonna
be very similar to laparoscopicin terms of what we do and you
know , what the incisions arelike. It just gives us a lot
more flexibility with whatsorts of things we can do
through small incisions.
Speaker 2 (20:54):
How commonly do you use the robot on hernias? I
know there's other indications,right ? Not just hernias, but
do you use it very often forhernias? Uh,
Speaker 3 (21:01):
It's my preferred approach for hernias and part
of that is because I, I do havethat really good visualization
with a good camera. I have theinstruments that can articulate
and do basically the samethings as my own hands can do
when I'm open. So it
Speaker 2 (21:14):
Simulates your hands. That's
Speaker 3 (21:16):
Interesting. Yeah , the laparoscopic instruments
are basically sticks. You cankind of move up and down and
back and forth, but you're ,you're fairly limited in some
of those more finer motions.
The robot allows us to sort ofreplicate open surgery through
a small incision. That's
Speaker 2 (21:29):
Super cool. So you're sitting in the room?
Mm-Hmm.
Right next to the robot. Yes .
Looking on the screen. That'sall very high tech .
Speaker 3 (21:37):
Yes. And the robot can do nothing independently of
a surgeon operating it. Yeah .
You're
Speaker 2 (21:41):
Not sitting at home with a cotton . Yeah . Like,
you know, eating bon bonds .
Right . And you know, and andyeah. Have the robot do that
surgery. Right . You're rightthere operating it. Yeah .
Speaker 3 (21:50):
Yep . I'm three feet from the patient.
Speaker 2 (21:52):
Somebody actually asked me that. Mm-Hmm . They
said what ? What does somerobot come wheel ? They're
thinking of something like fromthe Jetsons or something, you
know , something comes wheelsin and has a face. Mm-Hmm . And
everything. That's not it. No .
You are sitting there with thisextraordinarily advanced piece
of technology and you'resitting right next to it
operating it. Yep . Let's talkabout what patients can expect
who are anticipating a herniasurgery and then what they can
(22:12):
expect for recovery. Before Ilet you go here, how do you
tell patients to prepareanything they have to know
getting ready for theirsurgery?
Speaker 3 (22:20):
Uh , the biggest thing I would say is healthy
habits. The more fit you aregoing into surgery, the better
you're gonna recover.
Nutritious diet, high nutrientsand especially protein is gonna
help you recover from surgery.
If they're using tobaccoproducts of any kind, I
encourage quitting in order toreduce wound complications and
if they happen to havediabetes, controlling blood
sugar well before surgery.
Speaker 2 (22:41):
Okay. So that's what you do ahead of time. You get
your surgery done at your localcenter. What can someone expect
in recovery from all three ofthose types? Robot,
laparoscopic or an opensurgery? Yeah,
Speaker 3 (22:53):
So pain for any of them, the pain is gonna be
worse. The first 72 hours iswhen you're gonna have the most
pain after surgery. Um, theopen is gonna have the most
pain of the three. The roboticand laparoscopic are gonna be
similar to each other. They'regonna have less pain.
Speaker 2 (23:06):
Is that just 'cause the incisions are smaller?
Speaker 3 (23:08):
Yeah. And then after that first 72 hours, you're
gonna start to feel a littlebit better. Every day you're
gonna be sore, noticeably sorefor a cup for about two weeks.
And then I usually tell peopleby four to six weeks is when
they're kind of at that pointwhere they don't really notice
it anymore. In between the twoweek point and that point
you're still gradually gettingbetter every day. You're kind
of still feeling twinges whenyou move around. But the really
(23:31):
the serious, you know, takingit easy recovery is more the
first couple weeks.
Speaker 2 (23:35):
So do you tell people to lay off your
activities or don't go to workor particularly if you're doing
lifting and things, I wouldimagine
Speaker 3 (23:42):
Yeah, we tell 'em to avoid strenuous activity, but
walking is really, really goodfor people after any kind of
surgery and certainly herniasurgery. So we encourage people
to treat recovering fromsurgery like it's their job and
say okay, I need to go on saythree walks every day and in
between otherwise getting alittle extra rest, making sure
they're getting good nutrition.
It seems
Speaker 2 (24:02):
Like that's always the case in patients. So I say
these surgeons are ruthless.
They say you gotta go walk anddo things. I just wanna sit on
the couch. That's not the rightplan, huh?
Speaker 3 (24:10):
No, unfortunately you recover faster if you walk
more. And the other thing wenotice is that our patients who
walk more after surgery andwalk sooner after surgery
report less pain sooner. Thosefirst few times of getting up
are definitely sore, but themore you do it, the faster that
it gets easier and the betteryou recover.
Speaker 2 (24:29):
Really good tips.
That's good Tips for a speedyand a healthy recovery. Okay.
So before we get away from theactual surgical technique,
'cause this is fascinating, notonly to me, but I bet a lot of
people, some people come out oftheir hernia surgery, they have
one little, you know, threeinch long incision and then
other people have re reportedsurprised that they have three
incisions, although they'resmaller and I think it's
(24:50):
obviously related to thetechnique used . Why three
incisions versus the one? Couldyou explain that?
Speaker 3 (24:55):
Yeah, so through either the laparoscopic or the
robotic techniques, we're usingbasically a very small incision
for each instrument. And sotypically there are three of
them. We have a camera and thenwe have two hands versus the
open. It's gonna be just theone bigger incision that's big
enough for us to get our handsin there and repair this
directly.
Speaker 2 (25:12):
Okay. So when, so if you came outta your hernia
surgery listeners and you hadthree little small incisions,
don't worry they didn't trythree times, right ? It was
three different
into your belly. I have oneother question. How likely are
they to recur? In other words,once you get this fixed, are
you good for life and if theydo recur, is it at the same
(25:32):
place or, or , or somewhereelse? Could you say something
about that?
Speaker 3 (25:36):
Yeah, so different hernias have different
recurrence risks. Um , theinguinal groin hernias that
we've been talking a lot about,the recurrence rate for that is
around 5%. So it's about one in20 of them will will come back
even after surgery. And that'swith mesh. That rate is much
higher if we didn't use mesh.
That's why we do use mesh sooften. So
Speaker 2 (25:52):
5% in the first year or you mean 5% for lifetime in
your life? You got a one in 20chance? Mm-Hmm
might come back,
Speaker 3 (25:59):
Right? Recurrence is most common within the first
three years, but it's a risk.
Anytime ventral hernias andlarger hernias, especially
those that are already from asurgical incision have a much
higher risk of recurrence.
Speaker 2 (26:12):
Okay. Is that because the mesh failed or it's
around the mesh or , or whywould they recur? Those
Speaker 3 (26:19):
Locations are an area of higher pressure. So
just everything that you do allday is putting more tension on
that main part of your abdomenthan it is on the groin. Also,
those are areas that werealready weakened by a prior
surgery and we reinforce withmesh, we repair that tissue,
but nothing brings back thattissue strength once it's been
reduced.
Speaker 2 (26:37):
Yeah, that makes sense. That really makes sense.
Well, Rachel, thank you fortalking with us about hernias
today. We've been talking withDr. Rachel Payne. She is a
surgeon here at HennepinHealthcare in downtown
Minneapolis. We've been talkingabout abdominal wall hernias,
so lots of information on thisshow that applies to so many of
our listeners. So I want tothank you for being on the show
today.
Speaker 1 (26:56):
Thanks for having me.
Speaker 2 (26:57):
I've learned a ton about hernias and I hope you
have as well listeners. Ournext episode will drop in two
weeks and I hope you'll join usfor that one. In the meantime,
be healthy and be well.
Speaker 1 (27:09):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(27:31):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At Highball Executiveproducers are Jonathan , CTO
and Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(27:52):
time, be healthy and be well.
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