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Gut check: Understanding causes, types and treatment for hernias

Jul 30, 2020

Surgeon Dr. T. Ellis Barnes IV explains how robotic surgery has created a minimally-invasive treatment option to repair hernias

When you hear the word hernia, do you think of a painful result to lifting something heavy? Or something mostly men have to deal with?

There may be more to hernias than you realize, including the different types of hernias and the fact they can occur in men, women and even children.

Dr. T. Ellis Barnes IV

Did you also know hernias never go away without surgery? But thanks to robotic surgery, you have a minimally-invasive, quick recovery option for hernia repair.

A hernia occurs when tissue or part of an organ goes through an opening in which it doesn’t belong, explains Dr. T. Ellis Barnes IV, general surgeon with Metro Surgical. Hernias often create a bulge that can be painful for some.

There are different types of hernias. Some of the more common ones are:

  • Inguinal Hernia: This type of hernia occurs when tissue, such as from the intestine or colon, protrudes through an opening or weak spot in your lower abdominal wall, known as the groin. The hernia causes a lump in your groin and over time may get bigger. These types of hernias are most common in men because of natural weakness in this area.
  • Hiatal or paraesophageal hernia: In a hiatal hernia, part of your stomach pushes up through a natural opening (the hiatus) in your diaphragm, which is the muscle between your stomach and chest. In most cases, your food pipe (esophagus) goes through the hiatus and joins your stomach. However with a paraesophageal hernia, the top part of your stomach moves up through that opening and sits next to the esophagus.
  • Ventral hernia: A ventral hernia occurs when a bulge of tissue goes through an opening of weakness within the abdominal wall. Symptoms often include pain in the abdomen, especially when lifting something.
  • Incisional hernia: Many ventral hernias are also called incisional hernias because they form at the healed site of past surgical incisions. Unlike other types of hernias, incisional hernias occur at unnatural openings, such as a surgical repair that comes undone or a hole that results from trauma, such as a car accident.

What causes a hernia?

Almost all hernia types are caused by a combination of pressure and an opening or weakness of muscle or tissue. Basically, the pressure pushes an organ or tissue through an opening or weak spot.

There may be different reasons pressure occurs to cause a hernia including:

  • Lifting heavy objects
  • Diarrhea or constipation
  • Persistent coughing or sneezing
  • Repeated vomiting
  • Pregnancy

Lifestyle factors – such as obesity, poor nutrition and smoking – also can weaken muscles and make hernias more likely.

How do you treat hernias?

The reality of a hernia is it never goes away, Dr. Barnes says. Some people can live with them, while others experience regular pain and choose to have the hernia surgically repaired.

“You can live with a hernia,” Dr. Barnes says. “I know people who have ignored it for 30 years. It doesn’t bother them. They just push it back in and are fine.”

But it’s important for hernia patients to know it’s never going away and it will get bigger and the pain may become worse, Dr. Barnes adds. Hernias also can become a serious health problem. If the bulge becomes too painful, can’t be pushed back in and the skin is changing around it, Dr. Barnes says get to the emergency department.

“Most people, when they learn it’s never going away, want it fixed.”

How you fix it has come a long way over the years thanks to advances in technology. Dr. Barnes performs almost all his hernia repair surgeries robotically through the da Vinci Surgical System, which is available at St. Joseph’s Hospital, Candler Hospital and the Pooler Campus.

Robotic surgery is a minimally-invasive technique that allows for a faster, less painful recovery for the patient. For the surgeon, it allows for better vision, better control and better access.

“I think robotics has done a tremendous amount of good in terms of staying minimally-invasive,” Dr. Barnes says. “It gives me a lot more flexibility in terms of dissection, resection and then doing reconstruction of anything you have to resect on the robotic system.”

Related Article: What is robot-assisted surgery?

During a hernia repair, Dr. Barnes will use the arms of the da Vinci robot to make three tiny holes in the area of the hernia. Then, depending on the type of hernia, he will work to either remove the tissue bulge or reinforce the closure so organs and tissues no longer go through the opening.

“I control everything the robot is doing. The robot is the instrument, and I control the instrument,” Dr. Barnes explains. “Because I have wristed instruments, I have articulation that allows me to do a more precise dissection. It allows for softer grasping of tissue, which leads to less tissue damage, and it lets you do much more precise reconstruction as you are sewing things.”

If you or a loved one are living with a hernia, just know you don’t have to live with the discomfort. Surgery has come a long way, creating a less invasive, quicker recovery process for you.

Dr. Barnes sees patients in Richmond Hill (Mondays) and Savannah (Thursdays). For more information, call the Metro Surgical Savannah office at 912-826-4057.

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