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Johns Hopkins Bayview News - Back to Basics

Fall 2014

Back to Basics

By: Martin Fisher
Date: October 6, 2014

Complex hernia surgery helps patient return to life’s simple pleasures


Eva Sherman Hejazi posing at her home in front of her chicken coop
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Eva Sherman Hejazi at her waterfront cottage where she raises chickens as a hobby.

Two years ago, Eva Sherman Hejazi’s Halloween got off to a scary start. While lifting an armload of pumpkins, the 49-year-old felt something give in her abdomen. A hernia, which had been repaired seven months prior, had reoccurred, and worse, she now had a second hernia. After years of complicated health problems and multiple operations, Hejazi was worried about the impact this injury would have on her life in a waterfront cottage in Annapolis, Maryland, where she raises chickens.

More Than Just Discomfort

Many people consider their hernias to be no more than an uncomfortable nuisance, but they can actually be life threatening if left untreated. Although there are several types of hernias, they all share the same general characteristic: a gap in the muscle layer that can allow abdominal tissue to push through. “If this tissue gets stuck through the defect and gets twisted, it can cut off its own blood supply, which is called incarceration,” says Hien Nguyen, M.D., director of the Johns Hopkins Comprehensive Hernia Center. “That incarcerated tissue can start to die, causing a condition called strangulation. If a portion of intestine dies, that could lead to sepsis and, potentially, death.” This risk, says Dr. Nguyen, is the most important reason to fix hernias, in addition to the unpleasant appearance and discomfort.

Surgery is the only cure for hernias. Although devices called trusses provide some support and minimize symptoms, they do not repair or heal hernias. Additionally, patients with a truss may overexert themselves and cause the hernia to grow larger, leading to higher risk of incarceration and strangulation. Luckily, hernias are easily repaired, and repairs are very common operations, with approximately 700,000 surgeries performed annually in the United States.

Finding The Right Fix

There are several different techniques to fix a hernia, but there are two broad categories: open and laparoscopic. An open procedure uses a single incision to open the abdomen, while laparoscopic, or minimally invasive, procedures use multiple smaller incisions no larger than one centimeter to access and fix the hernia. Although not every patient is a candidate for minimally invasive surgery, the procedure can lead to less scarring and faster recovery time, as well as lower the risk of wound infections.

Some hernias, especially larger ones, require the use of mesh. The mesh holds the muscle layers in place while diffusing the stress across the muscle layers much better than sutures alone, reducing the risk of recurrence. It also helps reinforce the muscles as they heal. Since each approach has unique benefits and limitations, Dr. Nguyen says patients with hernias should discuss their options with their surgeon, who can ensure the best outcomes in their individual case.

Dr. Nguyen performed Hejazi’s first hernia surgery, and she turned to him again when her problem reoccurred. “Dr. Nguyen has such a good reputation,” she explains. “He answered every question I had—he’s very professional, but also has a great bedside manner. He makes you feel relaxed and comfortable.”

Ability to Handle the Complex Cases

Hejazi’s intricate repair operation required both a component separation and an abdominal wall reconstruction, and took almost seven hours to complete. Dr. Nguyen says, “It’s important to be able to take care of the complex patients,” who benefit from “the capabilities and excellence of my team and the great clinical nurses we have” at the Comprehensive Hernia Center.

The second operation was a success, and today Hejazi is back with her family, friends and chickens, enjoying the everyday pleasures of her normal life. “I like fresh eggs,” she smiles.

For more information on hernia surgery or to schedule an appointment, call 443-997-1508 or visit http://www.hopkinsmedicine.org/hernia_center/.

Sports Hernias

Sports hernias are not actually hernias. Although the symptoms are similar, the pain and pressure from sports hernias are caused by tears in the tendons that attach to the pelvis instead of an abdominal muscle separation. They are typically caused by repetitive activities, and are most common with highly athletic patients. Mild to moderate symptoms can typically be remedied with rest, anti-inflammatory medication and physical therapy. Patients with severe tears may require surgery to address the torn tendons. Dr. Nguyen says that many hernia specialists will not fix sports hernias without consulting an orthopaedic surgeon, but that any pain should be addressed with your care provider.

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