Healing Your Hernia

MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

Deborah Howell (Host): Welcome to the show. I am Deborah Howell, and today we'll be talking about healing your hernia with a very special guest, Dr. Jason T. Wong, who is a board-certified, fellowship-trained, laparoscopic and robotic surgeon specializing in the treatment of abdominal and digestive disorders in the safest, least invasive manner possible. Dr. Wong is affiliated with Saddleback Memorial Medical Center, is a member of the Society of American Gastrointestinal and Endoscopic Surgeons and the American College of Surgeons. We all know that straining can lead to a hernia, which can happen to men, women, and children. Today we hope to learn more about the causes and symptoms of hernias, as well as talk about minimally invasive surgical repairs. Welcome to the show, Dr. Wong.

Jason T. Wong, MD: Hi, Deborah. Thank you very much for speaking with me.

Deborah Howell (Host): Oh, it's our pleasure today. We're so grateful that you're here. I guess we'll start right from the get-go. What is a hernia?

Jason T. Wong, MD: Well, a hernia is when an organ or tissue squeezes out through a weak spot or a defect in the muscular layer. This can happen all over the body, but today we'll be concentrating on hernias of the abdomen.

Deborah Howell (Host): Those are the most common, correct?

Jason T. Wong, MD: They certainly are common, and they're a problem a lot of people have, although they may not necessarily know it.

Deborah Howell (Host): Okay. Well, let's talk about the common types. We've got ventral, inguinal, and umbilical.

Jason T. Wong, MD: Probably the most common type of hernia is what's called an inguinal hernia, or hernia in the groin. 25% of men or one in four will have a groin hernia in their lifetime and 5% or 1 in 20 women and they occur because the groin has an actual area of weakness where structures such as the spermatic cord in men enter and exit the abdomen. Also umbilical hernias or hernias in the belly button are very common. Some people may just note that they have an outie for a belly button. These are common in both children and adults. And ventral hernias are sort of a catch-all phrase for hernias anywhere else in the abdomen, and they're commonly seen where people have had previous incisions from surgery.

Deborah Howell (Host): Okay. I had no idea that an outie was an umbilical hernia. Wow, I've learned something today. Now we know. What would cause that?

Jason T. Wong, MD: Well, hernias can be a congenital condition with something that you're born with or in other cases they can be a result of an injury. Basically, the abdominal muscles serve as a jacket containing all of your organs and contents of the abdomen and when there's a little tear in that jacket, the contents can bulge out. So, belly button hernias like the you know, the “outies”, are often just something we're born with because before you're born it's actually open and it closes as you grow, although sometimes not entirely. And commonly with the hernias of the groin as well, there's a natural little tunnel there that can stretch and widen with time, but you can also tear that muscle by lifting heavy objects or by rapid weight gain that can also contribute to hernias as well.

Deborah Howell (Host): And what are the symptoms of a hernia?

Jason T. Wong, MD: The most common symptom of a hernia is a bulge, a bulge or a lump in one of these areas that you didn't have before. Some patients will have pain or discomfort with this bulge, but in other patients it's actually painless. The one common thread is that there is usually a lump in these areas.

Deborah Howell (Host): So not all hernias need to be treated?

Jason T. Wong, MD: Well, we certainly used to think that they did. The biggest concern or the worst thing that could happen with a hernia, which fortunately doesn't happen very often, is that the contents of the hernia can get stuck or what we call incarcerated within the hernia, and that bulge doesn't pop back into the abdomen. That's more or less an emergency because we're concerned that whatever's inside that hernia could be getting choked off, but that probably happens less than 5% of the time. So for the most part, if a hernia is bothersome and somebody wants to have it fixed, it's certainly something that should be fixed. But if it's small and doesn't cause any discomfort, then we can often watch it.

Deborah Howell (Host): Yeah, that's what I was going to say. Do you need to watch those small ones to make sure they don't become more dangerous?

Jason T. Wong, MD: You know, the biggest thing is that a patient, you know, should be aware that they have a hernia. That way, if it does suddenly become painful or problems, sorry, difficult, then they can seek medical attention.

Deborah Howell (Host): Okay, talking about medical attention, what are the different treatment options to repair these types of hernias?

Jason T. Wong, MD: Well, unlike other kinds of injuries, such as broken bones, unfortunately, hernias don't heal themselves. If you don't treat a hernia, it'll basically stay the same size or slowly get bigger with time. So the only way to really rid yourself of a hernia is to have a surgical procedure to fix it. Now the biggest advance in surgical procedures nowadays is that we usually use an artificial material, something that we call mesh, to reinforce the muscular layers in this area and that's how we fix hernias.

Deborah Howell (Host): Interesting. So it's almost like putting a little fence over it so it doesn't pop out again, right?

Jason T. Wong, MD: Very much so. Just like a fence or a patch and there's a lot of technology going into the design of these artificial materials which are permanent but inert. Patients don't react to them or have any kind of allergy or anything like that. And use of these materials has really improved the results and the chance of these hernias coming back after surgery.

Deborah Howell (Host): And what is the composite of these materials? I'm trying to imagine, is it a plastic type substance?

Jason T. Wong, MD: So they are basically plastic type substances. The most common types are either a polypropylene material, which would be like fishing line or a polyester. And if you could imagine a very flexible, like a window screen over your window, it would look like that, like a netting, which is soft and pliable and moves in all directions.

Deborah Howell (Host): I was going to say, it's got to move exactly in the direction of all the muscles and the musculature surrounding it.

Jason T. Wong, MD: That's right.

Deborah Howell (Host): And your approach is, when possible, minimally invasive?

Jason T. Wong, MD: So minimally invasive is basically a philosophy for use in surgery and basically that's to cause the least amount of damage when doing a surgery to speed a patient's healing. Now often this involves the use of small incisions, high technology like high-definition cameras or in some cases robotics and in hernia surgery is actually you can go both ways. Some hernias you know can be treated better with laparoscopic approach, particularly in functional hernias or hernias in the abdomen where you've had a previous surgery and also groin and umbilical hernias but you know in other cases even an incision over the hernia itself is a pretty small procedure so we both approaches, whatever is best for the patient.

Deborah Howell (Host): Sure, and let's take recovery time first for the standard surgery.

Jason T. Wong, MD: So generally the recovery time has to do with both pain and how much activity we recommend performing after surgery. And for the most part it takes the body about six weeks to really, you know, really heal from any kind of incision or any kind of repair. So in both a laparoscopic and open approach, we usually recommend no running, jumping, or heavy lifting, contact sports for about six weeks.

Deborah Howell (Host): No crunches.

Jason T. Wong, MD: Pardon me?

Deborah Howell (Host): No crunches.

Jason T. Wong, MD: That's correct. And then the other factor is pain. And in that case, with some hernias, such as groin hernias, a laparoscopic approach does lead to a less painful recovery. Usually patients will take about a week off work and the surgery itself is generally an outpatient surgery where you come in, have the surgery and go home the same day.

Deborah Howell (Host): Oh, that's great. That is wonderful to know. And what are some of the other benefits to patients with this minimally invasive approach?

Jason T. Wong, MD: Some of it has to do with cosmetics. Doing things laparoscopically do allow us to place the incisions in certain places which may be a little bit friendlier to the bikini body. But the main thing is postoperative pain.

Deborah Howell (Host): Wonderful, and I have a final question for you, Doctor. How do you determine if a patient qualifies for minimally invasive surgery?

Jason T. Wong, MD: That's really something that's best determined during a visit with the patient and their surgeon. Basically, depending on the kind of hernia and specifically whether a pair using a conventional technique or a minimum invasive technique would be appropriate is probably something that's best determined between a patient and their surgeon. But it is certainly a question a patient could ask.

Deborah Howell (Host): And the point to go to the doctor is, hopefully, before you're feeling pain, when you notice something different?

Jason T. Wong, MD: You know, I think it's reasonable whenever someone notices something different with their or in this case a lump or a bulge that wasn't there before. It's always a good idea to go to your doctor and even with a consultation of a surgeon, I certainly don't operate on everyone I see. So it's always good to have information about what's going on with your body.

Deborah Howell (Host): Absolutely, and we want to thank you so much Dr. Wong for being on the show today and giving us the full scoop on hernias and how we can treat them. For more information or to listen to the podcast of this show, please visit www.memorialcare.org. I'm Deborah Howell. That's it for this time. See you next time and have yourself a very wonderful day.