For some patients, a hernia is a harmless bulge in their belly or groin that is either watched by their doctor or repaired surgically. But when an abdominal hernia gets too large, surgical repair gets much more difficult and likelier to cause complications.
As a result of these risks and challenges, many surgeons don’t operate on people with large hernias.
“Basically, these are patients who have been turned down by pretty much every surgeon,” said Carlos Ortiz-Ortiz, MD, director of AdventHealth’s Minimally Invasive General and Abdominal Wall Repair Program.
Meanwhile, the hernia may become painful and can prevent people from walking. This lack of mobility can lead to weight gain, diabetes, skin infections and other problems. Many people with large hernias feel shame about their appearance and struggle to leave their home.
As a result, many of these people have depression and post-traumatic stress disorder, Dr. Ortiz said. Even with these far-reaching quality of life problems, they struggle to find a surgeon to help them.
“I have operated on multiple patients who’ve been looking for surgeons for many years,” he said.
Dr. Ortiz says AdventHealth’s new program creates a standardized framework for patients to follow before and after their surgery. The goal is to offer more options and the best care for people who want to recapture their former quality of life.
Neither the preparation for surgery nor the recovery are an easy road to tread. That’s why the program uses a multi-disciplinary approach with experts in nutrition and weight loss to support patients before and after surgery.
The relationships that Dr. Ortiz and his team form with patients often last for years.
To understand why a large hernia can be such a difficult problem to repair, it helps to know a bit about what they are.
What Is a Large Hernia?
As this post listing seven things to know about hernias explains, our muscles act like a curtain around our organs, holding them back. In some places — most commonly the groin but also elsewhere, like the stomach — this muscle wall can tear, allowing the organ to slip out.
It’s still covered by skin, and by itself a hernia is not a medical emergency. However, if the organ (most often the intestines) that’s poking through the wall gets trapped outside, its blood supply can get cut off. This is a true medical emergency and can even be fatal.
The hernia will not heal by itself, but surgery to repair hernias is common. (To learn more about hernias, check out our post.)
But if the hernia grows too large, surgery gets much harder and less likely to succeed.
Meanwhile, the person may lose the ability to walk. This creates a cycle in which they can’t exercise, often leading to skin infections, weight gain and other serious health problems, like diabetes.
Just as their quality of life is declining, the patient often has more difficulty finding a surgeon who will help.
“Most surgeons don’t have the necessary training to fix these hernias,” Dr. Ortiz says. Complications from these surgeries are common, and the surgeon needs a team that’s trained to meet these challenges.
But before surgery can happen, patients often need to lose weight.
Preparing for Hernia Surgery
The best medical evidence says surgery is most likely to be successful when patients lose at least 7 percent of their total body weight, Dr. Ortiz said. For a person who weighs 500 pounds, that’s about 35 pounds of weight to lose before surgery.
That’s not easy, especially when patients can’t walk.
The program has doctors and nutritionists who work with patients to make an eating plan that works for them. Because of the mental and emotional challenges that often come with a large hernia, the team may also connect patients with psychological or counseling services.
A Life-Changing Day
The procedure itself is a major operation. The surgeon is essentially rebuilding the patient’s abdominal wall, filling in the gaps left by one or more hernias.
The surgery relies in part on the patient’s own skin to close the hernia, but it will never be as strong as the original muscle wall. That’s why they use an artificial mesh patch to reinforce the repair when the hernia is bigger than three centimeters across, Dr. Ortiz says.
The surgery typically lasts from three to six hours, and patients spend about three days in the hospital. Full recovery usually takes about six to eight weeks. After that, the person should be able to walk, exercise and do just about anything they could before the surgery.
But surgery is far from the end of Dr. Ortiz’s relationships with patients.
“We’re not just fixing the hernia, we’re keeping track of our patients until we meet our goals,” he says.
Despite the challenges posed by abdominal wall surgery, Dr. Ortiz says he is motivated by his patients’ gratitude.
“They are so grateful and so thankful, that fills me up,” he says. “When I see a patient come back smiling because they can leave their house and go to the beach or the supermarket, I’m the happiest man ever.”
AdventHealth has assembled a team to help people with large hernias succeed in surgery and meet their personal goals. Because we care about the whole-person health of our patients, we help you through mental and emotional challenges, too.