Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare and what matters to you. And now here's our host, Dr. David Hilden.

Speaker 2: 0:19

Hey everybody, it's Dr. David Hilden, and welcome to the Healthy Matters podcast. This is episode 19, and today we are gonna talk about hernias. I'm guessing most of you listeners out there have heard of hernias before, but do you know exactly what they are and what can be done about them? Well, today we're lucky to be joined by Dr. Rachel Payne. She's a surgeon here at Hennepin Healthcare, where she is a trauma specialist, but also she's an expert when it comes to hernias and even robotic surgical treatment of hernias. I can't wait to get into that. Rachel, welcome to the podcast.

Speaker 3: 0:50

Thank you for having me.

Speaker 2: 0:51

It's great to have you here, Dr. Payne. Now first of all, many people have heard about hernias, and we're not gonna talk about everything under the sun about hernias, but could you just tell us what we mean when we say that term?

Speaker 3: 1:02

So, for the purposes of today, we're talking about abdominal wall hernias, which is a subset of a very, very broad term. Um, and loosely speaking, we're talking about a hole in the musculature in the abdominal wall and something coming through that hole from the inside that shouldn't be coming through it.

Speaker 2: 1:19

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 just something pushing through a hole. Well, you're , you can have herniated discs, you can have hi AAL hernias. There's other types. You can have herniations in your brain, to be honest. But we're not talking about any of that today. It's about abdominal hernias. So let's dive into that topic. What are the most common types of abdominal wall hernias?

Speaker 3: 1:42

So the most common is an inguinal hernia or a groin hernia. Those affect up to 25% of people who are assigned male at birth, extremely common. Next, most common would be a belly button or an umbilical hernia. And then ventral, meaning the main front of the abdomen. Often those are gonna be incisional, so they affect people who've had previous surgery.

Speaker 2: 2:03

I like it that there's always like a medical term inguinal. And then there's the term that we just don't like to talk about so much . Groin. And then you talk, I love that belly button . Hernia, the medical term, umbilical. So you said a very common one, especially in those assigned male at birth, is inguinal hernias. Mm-Hmm. <affirmative> . What causes that ? That,

Speaker 3: 2:21

So there can be quite a few different causes. One of the reasons that people who are assigned male are at higher risk is that the testes in a baby descend down into the scrotum through an opening. And that opening puts people at risk of hernias for life.

Speaker 2: 2:36

They start out higher. Mm-Hmm. <affirmative> and they descend down into the scrotum. And, and so they go, when you say descend, they're attached to something obviously. Yes . You know, they're not just free floating down there. Right . But they're attached on this structure, this cord does that hole not close up or what's happening?

Speaker 3: 2:51

The blood vessels and the nerves , um, as well as the tube that carries sperm is actually going through that spot. So the hole can't completely close around it . Those structures have to be

Speaker 2: 2:59

There. And so why do we get a hernia there? And you don't get a her , well, I suppose you can get it when you're younger, but I always think of it's like a little bit older guys. Is that true?

Speaker 3: 3:07

It's both. They're pretty common in babies too, actually.

Speaker 2: 3:10

Hmm . Do you do those?

Speaker 3: 3:11

I don't. Pediatric surgeons do those. Okay.

Speaker 2: 3:13

So why does that happen? In older men or, or women too? Yeah , but mostly in older men. Yeah. Yep .

Speaker 3: 3:18

Strain on the area over time. Weakening of that tissue, which can, there's a lot of different factors to that. Uh , people who lift heavy, especially over an entire career, if they do really strenuous manual labor. Other conditions that require medications like steroids, smoking and tobacco products,

Speaker 2: 3:36

Smoking leads to worsening risk of hernia. Yep . I think smoking's a risk for everything.

Speaker 3: 3:41

Pretty much everything

Speaker 2: 3:42

Bad. I'm noting that on this podcast . We've done this podcast for two, three years now, and smoking ends up being a risk factor for things that people don't think about. Even a risk factor for hernia. Mm-Hmm. <affirmative> and lifting manual labor. Mm-Hmm . <affirmative> . Not just weightlifters, you're just talking about people who lift in their jobs. Is that what you're saying?

Speaker 3: 3:58

Yep . People who are doing very strenuous, heavy lifting day in and day out.

Speaker 2: 4:02

Anything that people can do to lower your chances of getting it? Or is this just if you lift things or, you know, if you're on corticosteroids or you smoke too much, you just have to take your chances.

Speaker 3: 4:12

Maintaining good core strength and staying generally healthy, having a healthy diet, avoiding tobacco products. Maintain a healthy weight to the best of your ability. People who have diabetes, keeping good blood glucose control.

Speaker 2: 4:25

So you're gonna tell us to like all that healthy living stuff? Yeah . Okay . So we all ,

Speaker 3: 4:28

All the same things that are good for every condition. Yeah. It's good

Speaker 2: 4:30

For your hearts. Good for your hernia. So we got a surgeon telling you, you know, also healthy living things . So that, but no, in all seriousness, that makes perfect sense. That is really good advice to start out. We should always exercise more to the best. You can keep your weight under, under control. And I say to the best you can and as you did too, as the best of your ability. Um, don't feel bad about yourself. Right . I mean, you had , it's not a character flaw, <laugh> . No, 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 I had an inguinal hernia? How would, how would a person know? The

Speaker 3: 5:03

Most common thing is that people notice a bulge or a lump in their groin. Sometimes it can present as a lump or a bulge in the scrotum as well. Does it hurt? Sometimes it does. You may feel a dull aching sensation in the groin or in a belly button if it's a belly button . Hernia. Especially after a lot of activity or prolonged standing. You ,

Speaker 2: 5:21

You mentioned belly button hernia. So I do want to , before I get into, like what do we do about it and how do you diagnose it and all that. We've talked about inguinal hernias in the groin or the scrotum. What's the belly button hernia all about? Why do you , you like pop through your belly button? Yeah . Is that what you're saying?

Speaker 3: 5:34

Yep . And so some people will notice a lump in their belly button or immediately around the belly button or pain in the belly button.

Speaker 2: 5:40

So I, I do primary care. I, I see loads of people with hernias and loads of people. Actually, they , they do show me, you know, this little bulge at their belly button or, or in their groin. But I hear it all the time in the belly button and then you push it back in. So you say a bulge, is it a bulge that's always there or only when you're doing certain things or, or is it just always there? Like this big lump?

Speaker 3: 6:03

It depends on the size and severity of the hernia. Early on, most of them are gonna come and go. They can be, as you mentioned, manually pushed back in. You may notice them sticking out more with more activity or standing for prolonged time. As hernias get more severe. Sometimes they do just stay stuck out and become a permanent bulge.

Speaker 2: 6:21

Is it dangerous?

Speaker 3: 6:22

It can be. And especially when they get to that point, if what's permanently there, that bulge is intestine or another organ stuck in that hernia, that can actually be life threatening.

Speaker 2: 6:31

Okay. Say that again. So your intestines sticking out the hole,

Speaker 3: 6:34

That is one thing that can get stuck in a hernia. I

Speaker 2: 6:36

Mean , I kinda know some of these answers, but I want you to say that to

Speaker 3: 6:38

People . Yes . You can get intestines stuck in the hernia.

Speaker 2: 6:40

Just to get a little bit deeper into that. You've got this bulge. Mm-Hmm. <affirmative> , we all know it's a hole in something underneath the skin. The, the , the connective tissues, the musculature, the abdominal wall, the fascia, all that stuff . But is that actually your intestines pushing up through there? Are people, is it literally someone's intestines just protected from the outside by a layer of skin at that point?

Speaker 3: 6:59

In most cases, no. The vast majority of hernias, the lump that you're feeling is fat that's in there designed to protect your organs that we all have. But in some cases it is intestine that can be dangerous. That's when it gets dangerous.

Speaker 2: 7:10

Okay. So lots of people are thinking like , yeah , I got that. I got a little bulge coming out there . It doesn't hurt me so much and it doesn't bother me all that much. It's either my belly button or my groin and I just push it back in there. We're gonna talk after our break when we get to that portion about how you diagnose that and what is done about that. But before I get to that, how would a person who's been living with this, some people are living with this for a long time, how would a person know that there's a danger here? You know, I don't know. I've had this thing for two, three years. When, how would they know?

Speaker 3: 7:40

That's a very hard thing to know. And that's part of why we say as soon as a hernia is to the point where you can recognize that you have it, it's time to get it looked at by a surgeon. Mm-Hmm.

Speaker 2: 7:50

<affirmative>. Okay. Yeah. So I see people all the time then they've got these things forever and ever. And I usually say, now's time, you need to go see a surgeon now . 'cause this is not gonna get better all on its own . Mm-Hmm . <affirmative> . So before we leave inguinal hernias, is it on just one side or is it both sides? Or do you often see it, you know, literally on both sides at the same time?

Speaker 3: 8:07

You can see it on one or both sides. It's pretty common for people that have one to have one on the other side as well.

Speaker 2: 8:13

Wow. Okay. Now there's some other kinds that people can get. There's some femoral ones. And you mentioned ventral ones. Mm-Hmm . <affirmative> . Could you say a little bit more about each of those?

Speaker 3: 8:21

Uh , so femoral hernias , uh, are going through a , a hole where the blood vessels that go to your leg are so people feel those in the thigh. Those are much less common than the other types we've talked about. Ventral hernias can happen anywhere on the abdominal wall. They also are very common in people who've had previous surgery at the site of previous incisions. So

Speaker 2: 8:42

Is it the, is it because that , that's a place of weakness in the abdominal wall? Exactly . Yep . Yeah. And the femoral one, you said it's down in your thigh? Mm-Hmm. <affirmative> , uh, is that, I don't see those as much. Mm-Hmm . <affirmative> . And so I'm glad you said it's a little less common. 'cause I don't see those quite as much. Is that just as common? Men, women? Those

Speaker 3: 8:58

Are more common in women.

Speaker 2: 8:59

Do we know why that is?

Speaker 3: 9:01

Uh, we don't really, yeah. We especially see them more as people age. Okay . And with significant weight loss, they tend to show up.

Speaker 2: 9:06

And so we've talked about risk factors of smoking and lifestyle and putting pressure on that. What about pregnancy? You didn't mention that. Is that a risk for any of these types?

Speaker 3: 9:16

Pregnancy is a risk factor, especially for the belly button and the ventral hernias. It's additionally a risk for recurrence if say you've had one of these hernias fixed before and then you go on to have a pregnancy,

Speaker 2: 9:27

Because I've heard about that one a lot. There's a ton . Speaking of pressure in the belly. Yep . Having , uh, a developing pregnancy. Yeah . Uh , has to be just a ton of pressure. Okay. So now that we've learned a lot about all these different types of hernias, I think we've earned herself a break. And I'm gonna ask Dr. Payne when we come back to shift gears and tell us how does she diagnose them , uh, when you go to see her and how she makes the decision that some surgical treatment is needed. And then finally , all the various types of ways that a 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 for you, your life and all that it brings. He up in healthcare has a hospital HCMC and a network of clinics both downtown and across the west metro. They provide all the primary care and specialty care you would expect to find. But did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis? Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 10:38

And we're back talking to Dr. Rachel Payne, a surgeon at Hennepin Healthcare in downtown Minneapolis. And we're talking about hernias. In our first half. We talked about the various types of them, but now we're gonna get into how they're diagnosed and treated. Before we do that, I want to ask you , uh, Dr. Payne , when is it concerning? In other words, what signs and symptoms would a person experience to think that it's more of an 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 and out on its own and now it's stuck, that's a concerning sign. Especially if you're, if that's coming on with a lot worse pain , um, changes to the skin color over the hernia. If you're feeling otherwise ill with that. Like you're having fevers , uh, maybe you're throwing up, you're not pooping or passing gas. Those are all signs that maybe there's intestines 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 you have any of those things , uh, listeners, please do go to an emergency department in that case because that little piece of bowel can get pinched off and die off. And that's a big deal. Okay. In the absence of that emergency situation, I'm glad we covered that, but in the absence of that, let's talk about how you diagnose it. So I got this bulge, it's Cummins in and out. I can push it in there. It's coming through my belly button. I go to my surgeon. What are you gonna do to a diagnose it to make sure? And then how do you decide what, 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 really all you need , uh, to know the diagnosis and to be able between the exam and talking to the patient and finding out what symptoms it's causing. Sometimes that's all you need. Um, if the diagnosis isn't entirely clear or you're worried about whether there's intestine or other complicating problems, we might do an ultrasound or a CT scan, depending on how much more information we need.

Speaker 2: 12:37

Some of them even I can do as a primary care doctor, I can see the umbilical hernias. I can push it and reduce it. I can push it back in there. But some of 'em are a little bit more subtle. Do you still do what many, especially men of a certain age, remember? Mm-Hmm . <affirmative> like the military used to do this thing . Maybe they still do. Okay guys, line up. Turn your head to the side while I put my finger in your groin and you're gonna cough. Mm-Hmm . <affirmative> . Yep . Do you still 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, what we're actually feeling is the external inguinal ring, which is the opening of where the blood vessels and the nerve and the sperm tube go down into the testicle. And that's the spot where we can feel something herniate from inside to outside when 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 . <affirmative> That's the pressure sensation. Yeah . Yeah. So that is still taught in medical schools. 'cause it's, that's an effective way to do it. Yep . You usually don't need ultrasounds or other imaging, but you can do these in your sleep. Um, you probably get these quite a bit. So you're diagnosed in the clinic, there's various surgical options. Before we get into what those are, is there any non-surgical things that people consider if they're just like, Nope, I'm not having you operate on me.

Speaker 3: 13:50

There's nothing that's going to fix or reverse a hernia short of surgery. But in certain patients who maybe are very, very early not having a lot of symptoms, maybe they have medical problems that make surgery higher risk. Some things that we can recommend to people are things like abdominal binders or hernia belts, bracing the hernia. So holding it in when you're coughing or straining to have a bowel movement, for example. Um, we do also recommend that people try to avoid constipation because that's another source of straining. So we'll recommend fiber and stool softeners when necessary.

Speaker 2: 14:24

So those are not reversing anything? No . But they might help a little bit and 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 your best move there. You know, we're recording this during the summer Olympics . So I, I'm an Olympic fiend. I love watching the Olympics <laugh> , but I will not be an Olympic weightlifter, I'll tell you that. Okay. So there's various types of surgeries. I know there's open, there's laparoscopic, there's robotic. Could you talk us us through those ? 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 hands and our instruments directly to, to fix that. In the case of a groin hernia, we're talking about an incision that's , uh, maybe three to four inches in the groin, kind of right over the hernia. And we're with any of these surgeries, we're finding that area , that hole, we're finding whatever's coming through from the inside of the abdomen, putting it back where it belongs, repairing the hole and reinforcing that weak area with a piece of mesh.

Speaker 2: 15:22

Okay. So then a lot of people have heard of mesh. In fact, some people are scared of mesh. Yep . People hear about, oh no, I don't want that. 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 buy window 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 that we're using for these common groin hernias is made of polypropylene. So it's a , a plastic compound. It's really similar to this material. A lot of our sutures are made out of , um, so if you get a suture repair, you get the same material. 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 it like 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 fully solid, 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? Is that what you do? You can just cut it to size and, and that goes 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 go through the edge of the mesh and through the patient's tissue. So

Speaker 2: 16:25

Why are people worried about it? So there , maybe that's speculation, but what , 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 . <affirmative> . Anytime we put something foreign in the body, there are risks. Uh, infection is a common one. Mesh eroding through tissue into other structures. If it gets into the abdomen, gets into intestines, that can be a really big problem. Thankfully that's extremely rare. Mm-Hmm . <affirmative> a lot of the, you know, if people are seeing hernia lawsuits on tv, those are usually more advanced complex meshes designed for these really serious abdominal wall reconstructions. Those are very different than the types of mesh that we're usually putting 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're they'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 that is out there quite a bit. Mm-Hmm. <affirmative> . And it should be noted at the vast majority of people we're talking millions of people Yep . Are walking around with mesh and 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 thing every year? 20 million hernias. And so you hear about a few that went , yeah , the , the rare that the complications that the vast majority of those 20 million are doing just fine. So that's an open surgery. You put a little mesh in there, you sew it all up, you put the skin over the top of it and they go about their business. What about, what's laparoscopic then?

Speaker 3: 17:45

So laparoscopic, we're making a few very small incisions about half a centimeter and then putting in a camera and long thin instruments. So we're operating from the outside using a camera picture 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 to look 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 we do the procedural laparoscopically, another big benefit is that we can evaluate both sides from the same at the same time. So if say you have a hernia in both groins, we can see them and fix them in one surgery. Uh, there's also a lot less pain associated with that surgery. We're looking at the same hole in the same tissues. Just from the inside instead of from the outside.

Speaker 2: 18:28

Okay. Okay. And you still put mesh in there? Mm-Hmm . <affirmative> and the , like how many are, are , are these equally common or or is it mostly surgeon preference or is it just patient preference? How do you decide which way to go? They're

Speaker 3: 18:40

Both still very common. It's increasingly laparoscopic and minimally invasive techniques are more common. But there's surgeon preference and skill plays a role. Patient preference plays a role. Certainly one of the benefits to open hernias is that they can help you reduce very stuck or difficult hernias more easily. Especially if there's things like a lot of intestine in them. Um, sometimes we just can't safely do 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 at times in ways that you might damage it. And if you're looking at from the outside, you can more safely manage that. If you've had a prior hernia repair and then you have a recurrence, whatever type of repair you already had, those tissue planes are violated from the previous surgery and it's really hard to do the same surgery you already had. So usually we'll choose a different approach than what you 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 a risk for being fully asleep under general anesthesia, the open repairs we can actually do under what's called mac. So it's heavy sedation. You're not aware of what's going on, but you're still breathing on your own and you don't have a breathing tube in and you're not paralyzed with drugs for the surgery. And so that can allow us to fix hernias in people that have medical problems that would make it unsafe 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 the country that use a robot? Mm-Hmm. <affirmative> . That's cool as heck. <laugh> , but most people have no idea what that means. Yeah . What do you mean you bring in a little robot? You know, that comes wheeling in what? Explain robotic surgery.

Speaker 3: 20:13

So robotic surgery is upgraded laparoscopic surgery. Basically it's still small incisions where we're using a camera and long instruments that were operating from the outside. The difference is that the robot and the robotic instruments let us function with those small instruments on the inside. Much more like our hands function when we're doing open surgery, they, you know, they rotate a full 360 degrees. The robot also has a 3D camera and so we can see a lot better than we can with a traditional 2D laparoscopic camera. But overall the procedure's gonna be very similar to laparoscopic in terms of what we do and you know , what the incisions are like. It just gives us a lot more flexibility with what sorts 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 for hernias? Uh,

Speaker 3: 21:01

It's my preferred approach for hernias and part of that is because I, I do have that really good visualization with a good camera. I have the instruments that can articulate and do basically the same things 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 can kind 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 of replicate open surgery through a small incision. That's

Speaker 2: 21:29

Super cool. So you're sitting in the room? Mm-Hmm. <affirmative> right next to the patient. Yeah . Right next to the robot. Yes . Looking on the screen. That's all 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 and yeah. Have the robot do that surgery. Right . You're right there 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 some robot come wheel ? They're thinking of something like from the Jetsons or something, you know , something comes wheels in and has a face. Mm-Hmm . And everything. That's not it. No . You are sitting there with this extraordinarily advanced piece of technology and you're sitting right next to it operating it. Yep . Let's talk about what patients can expect who are anticipating a hernia surgery and then what they can expect for recovery. Before I let you go here, how do you tell patients to prepare anything they have to know getting ready for their surgery?

Speaker 3: 22:20

Uh , the biggest thing I would say is healthy habits. The more fit you are going into surgery, the better you're gonna recover. Nutritious diet, high nutrients and especially protein is gonna help you recover from surgery. If they're using tobacco products of any kind, I encourage quitting in order to reduce wound complications and if they happen to have diabetes, 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 local center. What can someone expect in recovery from all three of those types? Robot, laparoscopic or an open surgery? Yeah,

Speaker 3: 22:53

So pain for any of them, the pain is gonna be worse. The first 72 hours is when you're gonna have the most pain after surgery. Um, the open is gonna have the most pain of the three. The robotic and laparoscopic are gonna be similar to each other. They're gonna 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 little bit better. Every day you're gonna be sore, noticeably sore for a cup for about two weeks. And then I usually tell people by four to six weeks is when they're kind of at that point where they don't really notice it anymore. In between the two week point and that point you're still gradually getting better every day. You're kind of still feeling twinges when you move around. But the really the serious, you know, taking it 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 work or particularly if you're doing lifting and things, I would imagine

Speaker 3: 23:42

Yeah, we tell 'em to avoid strenuous activity, but walking is really, really good for people after any kind of surgery and certainly hernia surgery. So we encourage people to treat recovering from surgery like it's their job and say okay, I need to go on say three walks every day and in between otherwise getting a little 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 and do things. I just wanna sit on the couch. That's not the right plan, huh?

Speaker 3: 24:10

No, unfortunately you recover faster if you walk more. And the other thing we notice is that our patients who walk more after surgery and walk sooner after surgery report less pain sooner. Those first few times of getting up are definitely sore, but the more you do it, the faster that it gets easier and the better you recover.

Speaker 2: 24:29

Really good tips. That's good Tips for a speedy and a healthy recovery. Okay. So before we get away from the actual surgical technique, 'cause this is fascinating, not only to me, but I bet a lot of people, some people come out of their hernia surgery, they have one little, you know, three inch long incision and then other people have re reported surprised that they have three incisions, although they're smaller and I think it's obviously related to the technique used . Why three incisions versus the one? Could you explain that?

Speaker 3: 24:55

Yeah, so through either the laparoscopic or the robotic techniques, we're using basically a very small incision for each instrument. And so typically there are three of them. We have a camera and then we have two hands versus the open. It's gonna be just the one bigger incision that's big enough for us to get our hands in there and repair this directly.

Speaker 2: 25:12

Okay. So when, so if you came outta your hernia surgery listeners and you had three little small incisions, don't worry they didn't try three times, right ? It was three different <laugh> , three different instruments that went into your belly. I have one other question. How likely are they to recur? In other words, once you get this fixed, are you good for life and if they do recur, is it at the same place or, or , or somewhere else? Could you say something about that?

Speaker 3: 25:36

Yeah, so different hernias have different recurrence risks. Um , the inguinal groin hernias that we've been talking a lot about, the recurrence rate for that is around 5%. So it's about one in 20 of them will will come back even after surgery. And that's with mesh. That rate is much higher if we didn't use mesh. That's why we do use mesh so often. So

Speaker 2: 25:52

5% in the first year or you mean 5% for lifetime in your life? You got a one in 20 chance? Mm-Hmm <affirmative> 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 and larger hernias, especially those that are already from a surgical 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 why would they recur? Those

Speaker 3: 26:19

Locations are an area of higher pressure. So just everything that you do all day is putting more tension on that main part of your abdomen than it is on the groin. Also, those are areas that were already weakened by a prior surgery and we reinforce with mesh, we repair that tissue, but nothing brings back that tissue strength once it's been reduced.

Speaker 2: 26:37

Yeah, that makes sense. That really makes sense. Well, Rachel, thank you for talking with us about hernias today. We've been talking with Dr. Rachel Payne. She is a surgeon here at Hennepin Healthcare in downtown Minneapolis. We've been talking about abdominal wall hernias, so lots of information on this show that applies to so many of our listeners. So I want to thank 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. Our next episode will drop in two weeks and I hope you'll join us for 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 find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive producers are Jonathan , CTO and Christine Hill . Please remember, we can only give general medical advice during this program and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.