Surgeon Deals and 'Ace' to Lompoc Barber for His Repair

Hernias, like the one experienced by Tyler Flester, can range in location, size, and impact on quality of life. After receiving a hernia diagnosis, the best treatment for a hernia is often a surgical operation.

When he felt unwell last summer, Tyler Flester, a 33-year-old barber, wasn't sure what was happening. Every time he sneezed or coughed, he felt a sharp pain. It felt like something was in his groin area, but he couldn't physically see anything. Tyler decided he had better listen to his body's signals. He went to Lompoc Health Urgent Care, where he was told he might have a hernia.

What is a hernia?

A hernia occurs when part of your intestine or fatty tissue bulges through a layer of muscles in your abdominal or pelvic walls. In simpler terms, a hernia is a tissue that winds up in a space where it is not supposed to be. A hernia may increase in size when you "bear down" or strain, which is why Tyler's hernia was more apparent when he sneezes or coughs. Hernias are common and can vary in the amount of distress they cause. Some people may barely notice that they have a hernia, and others may be highly affected by it. Sometimes, hernias can lead to an emergent condition requiring immediate surgical attention.

What causes a hernia?

Several factors can cause a hernia, but one of the most common causes is heavy lifting or straining. Some people have genes that make them more likely to develop a particular kind of hernia, causing some hernias to run in families. Other risk factors for hernias include:

• Chronic coughing, sneezing, or vomiting
• Chronic straining to poop or pee
• Trauma
• A weak spot or opening in the tissue of the abdominal or pelvic wall (this could be present at birth or resulting from previous surgery)
• Chronic obesity
• Connective tissue disorders
• Diabetes
• Smoking cigarettes
• Natural tissue degeneration that occurs with aging
• A history of multiple pregnancies or lifting children

Another risk factor for a hernia is having an occupation that requires considerable standing, lifting, or walking. This was certainly the case for Tyler, who works as a barber and owns the Ace of Fades barbershop.

What are the different types of hernias?

There are several different types of hernias, and each is classified by where in the body it occurs.

Inguinal hernia

An inguinal hernia occurs in the groin, causing a bulge of tissue at the inner crease of the thigh on either or both sides. Inguinal hernias are the most common type of hernia. They are more likely to occur in men— in fact, experts note that 27% of men will experience an inguinal hernia at some point in their lifetime, compared to 3% of women. Tyler fit the bill for this type of hernia, and an ultrasound study confirmed that, indeed, he had a 1.5-centimeter inguinal hernia.

Femoral hernia

This type of hernia occurs when tissue bulges at the top of the inner thigh. This is more likely to occur in older women due to tissue degeneration.

Umbilical hernia

This type of hernia occurs when tissue bulges through the abdominal wall near the belly button (umbilicus). Umbilical hernias are more common in infants and young children but can occur at any age. In many children, this type of hernia resolves on its own.

Hiatal hernia

This type of hernia occurs when tissue bulges through the abdominal cavity and up into the chest cavity through an opening in the diaphragm. This may not cause any symptoms. However, when symptoms are present, they can be similar to those experienced with acid reflux (heartburn).

Incisional hernia

This type of hernia occurs when tissue bulges through an area with scarring from a previous operation.

What are the symptoms of a hernia?

A hernia is typically a painless lump; however, you may experience some dull or aching discomfort due to the irritation of tissues or the separation of tissues that are generally not separated. In Tyler's case, he was aware of his hernia because he felt symptoms every time he coughed or sneezed. If you have a hernia, you may remember precisely when you developed the condition. For example, you may have lifted a heavy object and suddenly felt a bulge in your groin.

Aside from a noticeable bulge, other symptoms of a hernia can include the following:

• Heartburn (hiatal hernia)
• Groin discomfort (inguinal hernia)
• Scrotal swelling (inguinal hernias in men)
• A feeling of fullness or problems having a bowel movement
• A burning sensation
• Increase in lump size with straining or after a big meal

It could be an emergency if you have severe pain in the area of a suspected hernia. If a hernia becomes incarcerated or trapped, it can cause vomiting, stomach pain, or bowel obstruction. If a hernia becomes so trapped that it cuts off the blood supply to the tissue, this is called "strangulation." This situation can cause severe pain, and it is a surgical emergency. If emergency surgery is not performed promptly, the involved tissue can die.

What to do if you have a hernia?

Once Tyler's hernia was diagnosed by an ultrasound study, his next step was to meet with a general surgeon, Dr. Peter Davis. During this meeting, Tyler learned about his treatment options and what to expect. He was gratified to learn everything he needed to feel prepared, and his treatment team was very good at educating him and making him feel informed.

If you think you may have a hernia, it's important to see a medical provider for an evaluation, just like Tyler did. While many hernia symptoms can be managed without surgery, it's important to have a physical exam to help characterize the hernia and rule out other conditions that could be causing your symptoms. Typically, a healthcare provider can tell if you have a hernia simply by performing a physical exam. Sometimes an imaging test, like an ultrasound or CT scan, can help better diagnose this condition.

When evaluating you for a hernia, your medical provider will ask questions about your condition, including when and how it occurred. They will want to know if the condition improves or worsens with certain activities and how much it affects your quality of life. For some people, a hernia can be managed without intervention, with slight activity modification.

A specific supportive belt can help you avoid worsening a hernia with daily activities. However, often, a hernia is not manageable with these measures, gradually worsening over time. In that case, surgical treatment can be beneficial.

How are hernias treated?

Once a hernia has occurred, it is not likely to get better on its own (unless it is an umbilical hernia in a child). Without activity modification, it can get worse and cause more limitations. For this reason, many people opt to pursue surgical treatment for their hernias if they have no compelling reasons not to have surgery. Surgical repair of a hernia is a common procedure, and general surgeons are highly skilled at performing this type of surgery.

Unless you have an emergent hernia condition, like an incarcerated or strangulated hernia, you can choose when you would like to have hernia surgery. A surgeon can walk you through the types of surgeries available, depending on your condition. The two main types of hernia repairs include minimally-invasive surgery and open surgery.

Minimally-invasive surgery

In minimally-invasive hernia surgery, a surgeon makes a small incision in your abdominal cavity and inserts a high-tech camera called a laparoscope. Through another small incision, the surgeon uses tools to help push away certain tissues and locate the site of your hernia. The hernia will be replaced into its proper cavity. Then a mesh patch will be used to help reinforce the herniated site and prevent a future recurrence.

Some surgeons also use robotic hernia repair techniques, like laparoscopic surgery, except a surgeon sits at a console away from the bedside while performing the repair. Robotic surgery can be even more accurate and may be useful for very small hernias or areas that are harder to access.

Open surgery

In open surgery, the entire hernia repair is done through a single incision in your abdomen. This incision will be longer than the small incisions made to carry out a minimally-invasive laparoscopic surgery. An identical repair is conducted using a mesh, and the area is secured together. If you have open surgery, you may require more time to recover, and you may have a more visible scar. However, some patients are more likely to have successful open surgery for hernia repair than the minimally-invasive option.

Tyler's Hernia Treatment and Recovery

Tyler's surgeon, Dr. Davis, recommended that Tyler take it easy physically until his surgery could be scheduled. This wasn't easy for Tyler, as he spends his days on his feet and is self-employed, but he knew it was in his best interest to follow the surgeon's orders. On the day of the surgery, Dr. Davis used an advanced Da Vinci Robotic System to facilitate a minimally-invasive laparoscopic repair. This operation went very smoothly, allowing Tyler to recover quickly in about two weeks. Throughout the process, Tyler felt he was in excellent hands—from Dr. Davis, who made him feel comfortable because of his warm body language, to the sweet nurses and perioperative staff who smothered him in warm blankets after the operation. Today he is feeling back to his usual self.

"The hernia pain is gone, 100 percent," says Tyler. "I feel now I can put more weight on it, easing back into it. Dr. Davis told me healing time is everything."

How to prevent a hernia

Some hernias may be hard to prevent, especially if you have certain risk factors or genes that make it more likely that you will develop a hernia. However, you can control some risk factors leading to a hernia.

To prevent a hernia:

• Reduce or stop smoking cigarettes
• Keep your body weight within an average BMI range
• Avoid heavy lifting or straining activities (and if you must lift, make sure to use the correct form)
• Eat fiber and drink plenty of water to avoid straining on the toilet
• Eat smaller meals
• Eat a healthy diet to reduce your chances of developing diabetes (or keep your diabetes under tight control)
• Increase your core strength to help improve your lifting biomechanics

How to learn more about hernia care at Lompoc Valley Medical Center

At Lompoc Valley Medical Center, we offer comprehensive hernia care, just like the expert care that Tyler received in his time of need. Our urgent care, internal medicine, and family physicians are adept at helping you diagnose and manage your hernia and determine if you require surgical care from our expert surgical team.

To be evaluated for a potential hernia, make an appointment with one of our providers today.