Carl Maronich (Host): This is The Pulse at Tallahassee Memorial Healthcare. I'm Carl Moroni, and with me today is Dr. James Parker. We're gonna be talking about hernias, what they are the most common types, and how they're. We'll also talk about the benefits of robotic surgery And what patient's can expect before and after treatment.

Dr. Parker, welcome to the podcast.

James Parker, MD, FACS, FASMBS: Thanks for having me.

Carl Maronich (Host): You are general bariatric, minimally invasive surgeon. Right? Very good. So you deal with a lot of hernias, and maybe we could start by just defining a, talking a little bit about what a hernia is.

James Parker, MD, FACS, FASMBS: Sure. And there are, quite a few different types of hernias and they, come about for different reasons, but, basically, the hernia is, organs or structures in the body that are pushed through, defects that aren't supposed to be there.

Carl Maronich (Host): You mentioned different types. There are different types of hernias.

James Parker, MD, FACS, FASMBS: Yeah. classically you think of the bulge of the belly button as the umbilical hernia, and that's, basically what the hernia is. But it's something that you can see, bulging. There are also hernias kind of internally as well, or that you can't see. So like hiatal hernias where you have hernias bulging through the diaphragm causing, reflux or trouble swallowing.

And you have groin hernias called inguinal hernias, which is bulging down, in the groin as well. many other hernias.

Carl Maronich (Host): Do they sym? Do the symptoms show up similarly or are there different symptoms for the different types of hernias?

James Parker, MD, FACS, FASMBS: hernias can cause all sorts of symptoms. most commonly hernias are asymptomatic. You see the BULs before you have problems with it. And so just a little bit of fat pushing through from a space where, fat's supposed to be pushing through the hole, bulging to the space where it's not supposed to be.

Carl Maronich (Host): How are hernias most often diagnosed initially?

James Parker, MD, FACS, FASMBS: Typically they're diagnosed on physical exam. you go see your physician, you complain of the bulge, and or pain. And then they're like, oh, yep, that's a hernia. Uh, belly button, hernia, inguinal hernia. Those are fairly easy to diagnose on physical exam.

Carl Maronich (Host): So I'm guessing typically a patient might have that conversation with their primary care provider first And then be referred to you for treatment.

James Parker, MD, FACS, FASMBS: Typically that's how it works. we do have a streamlined service with TMH where we have a hernia referral line. So if you suspect that you have a hernia, any site of hernia, uh, you could give us a call And we can get you scheduled directly with a surgeon, and skip the step of seeing a primary care doctor, if that's what you wanna do.

Carl Maronich (Host): You mentioned earlier, hiatal hernias, if I'm saying that correctly, how do they differ, from abdominal wall hernias in terms of causes? Symptoms and treatment approaches.

James Parker, MD, FACS, FASMBS: Yeah, so a completely different type of hernia, but still a hernia because it's, basically, where the stomach herniates or other organs herniate up through the diaphragm internally. and it can present in. Many different ways. and typically the, classic symptom is reflux. You can have small hiatal hernias, big hiatal hernias.

It doesn't matter what size A hiatal hernia is. A hiatal hernia when it comes to reflux because, basically we lose that valve that keeps acid in the stomach and it comes up when we're sleeping these extra pillows, all that kind of stuff. other symptoms that it can cause would be dysphasia, trouble swallowing, food, sticking chest pain, or some atypical symptoms, which could be from the acid itself, like throat clearing and burning, sinus drainage, chronic cough, those kind of things.

And so a lot of different symptoms with a hiatal hernia.

Carl Maronich (Host): What are the early warning signs patient's could look out for? when it comes to hernia, uh, before complications arise? And at what point surgical intervention needed typically?

James Parker, MD, FACS, FASMBS: Sure. So, when it comes to symptoms and, when surgery is needed, it depends on what type of hernia we have. So umbilical hernia symptoms, is generally. recommended to have that repaired regardless, because like we say, hernias don't get smaller, they stay the same or they enlarge and when they get bigger, And that can happen over time.

When we get older, tissues get weaker and more things can fit through the hernia. It can become an emergency. And so getting it fixed as soon as you see it is, typically recommended. but if, you wanna wait until you are having symptoms, typically you'll have symptoms of pain at the site.

Or symptoms of where you're throwing up or, having bowel obstructions. And in that case it is an emergency. so they can present a lot of different ways.

Carl Maronich (Host): What factors determine whether surgical repair or medical management is the preferred approach?

James Parker, MD, FACS, FASMBS: typically the workup for hiatal hernia starts with a patient complaining of reflux. And so usually if you're having some heartburn, you'll start on an H two block or a PPI, And then get referred to a gastroenterologist who will start working up the reflux. Increasing or strengthening the PPI doing endoscopies to take, to check for any sort of structural abnormality and diagnose the hernia.

when he gets into a surgeon. Usually we don't recommend getting these fixed until you failed medical management, or if you decide that you don't wanna take a PPI forever, let's do something to prevent me from having to take that. And then that's when we do some sort of a, hiatal hernia repair with some, anti-reflux procedure, which typically will get patient's off of their PPIs.

Carl Maronich (Host): The best treatment option, there are a variety of them from laparoscopic to open, uh, robotic in each. How do you determine which is the best, for the different types of hernia?

James Parker, MD, FACS, FASMBS: Sure. So, small asymptomatic hernias, Can be, managed with an open repair. I think that's reasonable. laparoscopic and robotic are fairly synonymous. and, a large portion of the country are actually moving from laparoscopic to robotic surgery just due to the ease of, operating. You know, we haven't really proven better outcomes, necessarily, but, there's a general consensus that we have better control, better vision, better tissue manipulation using the robot with much more fine movements.

And so most of us have gone to fixing hernias with the robot. And for me, typically I'll recommend a robotic repair unless it is a small umbilical or epigastric hernia that I'm repairing.

Carl Maronich (Host): In terms of recovery, what, can the patient expect, difference? Is between laparoscopic and robotic surgery.

James Parker, MD, FACS, FASMBS: laparoscopic and robotic surgery. We typically have fairly similar recoveries, and if we get down into the weeds of the differences in the surgery, robotic surgery, one of the benefits of of that surgery is that you can actually close the hole a lot easier than laparoscopic. And so when people repair these primarily laparoscopically, they're, they're taking a piece of mesh sticking up under the abdominal wall and just tacking it in with tacks, which.

Can cause pain all around the mesh that you placed in because you're tacking it all the way around. when we do this robotically, have the ability to close the defect fairly easily, which closes the hole And then also patches it with a piece of mesh, which doesn't necessarily require extensive tacking to keep it in place.

just a few sutures which dissolve within, a couple of weeks. And so I think that in terms of recovery, you can expect an easier recovery after robotic surgery And then less complication.

Carl Maronich (Host): certainly better. Sounds like recovery, from robotic compared to the open surgery.

James Parker, MD, FACS, FASMBS: yes, in a sense they're, the smaller And the. I aim all of my repairs in, order to try to ease the recovery in patient's and decrease the recurrence risk. a smaller open, hernia repair typically has a fairly simple recovery without too much pain. But once you get larger than One to two centimeters, you're starting to talk about using a piece of mesh to reinforce the repair, making bigger incisions, which, makes the recovery a little bit more difficult, and increases the risk of infection.

And so that's why I kind of prefer a robot, for those specific cases.

Carl Maronich (Host): From all that, it sounds like it gets back to something you said earlier about, getting it taken care of earlier and not waiting to have some sort of a treatment for the hernia.

James Parker, MD, FACS, FASMBS: Yeah. I think that, that, hits the nail on the head.

Carl Maronich (Host): Is always better as they say. Isn't that right? Very good. Well, doctor, a lot of great information. We appreciate you spending time with us and telling us all about hernias.

James Parker, MD, FACS, FASMBS: sure. Thanks for having me.

Carl Maronich (Host): Certainly. For more information and a request of surgical consultation, visit tmh.org/hernia. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library. For topics of interest, I'm Carl Moroni, and This is The Pulse at Tallahassee Memorial Healthcare. Thanks for listening.