Hernia, Dr Matt Goldblatt, Joel Lee discussed on Saturday Spotlight
Where the doctors and scientists from the Medical College of Wisconsin are making tomorrow better than yesterday for all of us in our final segment of this program, Dr Matt Goldblatt, and Michelle Weber will be joined by two of their patients. Joel Lee from Milwaukee, Wisconsin, and Nancy Baer from cedar Berg, Wisconsin. I think Joel, can we start with you? We're going to focus on, on inguinal groin hernias. I think your story covers virtually of, of challenges with groin or inguinal hernias. Maybe you can start with the first symptoms, you had before your first operation since I know you had a few surgeries. The first symptoms were on a golf course. Which you still frequent regularly, correct? Yes. Okay. Yeah. To the dismay of the pros. But that's okay. I was in two thousand six I walked off, of course, because I had intense pain them I left side, very low and Brian area. And with into the shower room where doctor was present and told me to take my pants on fight. Did he punched around a little bit? And says, I think you have a hernia sit come into my office went in a couple of days and prepared me for surgery. I had the surgery two thousand six and didn't have any adverse effects, but it did take me about three months after the surgery before I was able to start exercising and playing golf for tennis. And. Healing period. And the and the operation was performed open, right? And did they use a piece of mash or any other material? No probably not. And Matt, Dr Goldblatt, how frequently is our inguinal groin hernias repaired with or without mesh or some other material, I would say that the, the overwhelming majority of these days over paired with mesh there, you know, averages upwards of about ninety eight ninety nine percent, particularly in adults, so it's, it's unusual that, you know, especially today that we wouldn't use a piece of mesh that certainly is different than the past. I mean, this, this is a change that you would say occurred over the last decade or fifteen years or what would you say? Yeah, it's been evolving. Certainly over the last, you know, thirty years was when mash was, I really introduced as a as almost nice shouldn't say, the standard of care, but as a as a routine use, and its use has increased pretty much steadily ever since. That's correct. Michelle two months to recover is that kind of the long end of the spectrum. Would you think I mean so Joe? Dole was that the to get down to what's really important in life? Was that two months before you could golf knows too much before I could basically begin working out as to work out for five times week, everything from sit ups push so forth. And I just it took that long for me to feel able to do that. Because you had discomfort there. Yeah. Yeah. I think each patient's recovery is very individual based on other medical history, the type of repair that complexity of the repair, as well as the surgical approach. But typically, we say anywhere between four and eight weeks is pretty common in terms of recovery. Okay. So, so the first hernia is fixed, and after two months, all seems well, yes. And then then what happened? No further problems on the left side ever. Okay. In two thousand twelve I developed a similar type situation and I was on a golf trip. And we were getting in and out of the carton, playing thirty six holes a day for three days in a row and toward the end of it, it just got to the point where I couldn't get out of the car or sit down again I just had to stop went back in. Actually, Dr Gould, did the surgery out at freighter, and it was very quick. And I was actually up in around in less than four weeks. And so that was done. Laproscopy cly. No, that was done with an incision with incision also. Okay. And then over a period of the next couple of years, I would get occasions of tweaking in that area where it felt like a hernia. And I went and saw sports medicine doctor, and saw physical therapist, and nobody could feel anything and they just said, you know, leave it alone. See what happens in a little while. The end of the story was one day I was with a physical therapist. He he felt something popping out like from underneath where the mesh was a guess, and I don't know this medically but they tied it off on three sides, and whatever it was snuck underneath. And then it would go back and it would sneak out again. And one day he felt it I went back and again, Lapper Scott basically this time. So that was the let me before we get to the third operation, Matt. How if you if you have a hernia on one side, are you more likely to get a hernia on the other side? Yeah. It's, it's to have a bilateral hernia, which is what we would call that. It's, it's, it's more common than I think people realize it's somewhere between twenty to thirty percent patients will have a hernia on both sides. Usually one side is the one that's symptomatic and, and it's a pretty standard that when you go see a hernia surgeon. They'll check both sides because it's you know if you're going to be going, essentially. Under the knife. It's the best time to fix the other side would be while you're already in the operating room. So, yeah, it's pretty common. So you would fix both sides at the same time if if you notice that there was hurting on the other side, then I would fix it. It's not always evident. So I I'm not trying to insinuate that. There was a mistake made or anything like that. But just, you know it's not uncommon also to have a patient. Gotta hurry on one side. And then years later, one pops up on the other side. So the hernia on the right side now had was repaired with mesh, which, as you said, would be pretty typical and how do you secure? How do you secure the mesh, and whether you can describe, first of all, what is mesh? What are we talking about here? It's in a most of us envisioned like a little piece of the screen from our window. What is mesh? And then how do you actually secure it to the human body? So what you described. There's actually a pretty good description. It's it, it looks very similar to a window screen. It's made out. Of the, they're all made out of some sort of plastic. The two most common plastics are something called polypropylene, which is very similar to fishing line, and polyester, which most of us know is, is, is a fabric. It's not quite like the close fabric, but it's the same structure, and there are various ways to secure it. But most of the time you end up securing it to the patient's tissues, with suture typically a permanent suture that would hold the mesh in place. Now, the, the, the long-term fixation of the mesh is actually what the body does to it as it, basically encapsulates it, or it grows into the mesh, and that's what really holds in place. I use the analogy of it's like placing a lattice. In front of a rosebush and over time, the rose will grow into the lattice new can't pull the lattice away, because it's entangled with, with the tissues. So it's a similar type of process that happens. So Joel the so the, the physical therapist, actually helped you make the diagnosis of a little piece of intestine, or something, slipping underneath the mesh, which was giving you recurrent pain. And he for maybe the first three times I went to see him said, there's nothing they're nothing there. And then the third or fourth time he said, I feel something. Yeah. That's when I went to see doctors Goldblatt, and gold. So doctors, golden Goldblatt then reoprted on you. Yes. Okay. And Matt, what was the what was the operation that was done? That was done laproscopy. So essentially incision was made near the belly button. And we went in with a camera couple small little incisions for our instruments. The nice thing about doing that. Is that since his first operation was done open when we go in there? Lapper scott. We're really going into a separate surgical field. So we don't have to go through any of the scar tissue that was there. And it allows us to, to, as we mentioned earlier to get underneath the hernia reduce the hernia or pull. What's pushing through back in where it belongs. And then a piece of mesh there to stop it from pushing through again. So then Joel ended up with two pieces of mesh right one on the top one on the bottom. Correct. And how often the the complication that he experienced which it sounds like everything was fine for a couple couple years. Yes. For a couple years how, how common is that where where the mesh it sounds like the mesh dislodged a little bit of something? Yeah. Probably what happens is the, you know. The, the mesh didn't grow in as well as, as we hope it would on one of the corners, if in if it's a four, you know, it's, it's rectangle essentially, and you've got four sides to it. If it gives way on even on one side. There's a pretty good chance. It could slip away, or, or the hernia could push continue to push it away with what sounds like what was happening with Joel. Well, so happy ending to this Joel, not very happy with the doctors. My golf game has gotten any better. Well, we'll see. Doctor, Dr Goldblatt maybe you could help you with that. We'll see. We'll see what he has to say. Thank you very much, Nancy. Maybe I could ask Dr Goldblatt because your situation is, is, is, perhaps, even a little bit more more complicated to give a brief description of the first time that you met Nancy, and then we'll give have Nancy give her perspective on on everything that's gone on, so Nancy came to me with a complication related to hernia repairs, which is which is possible, but pretty on likely, and that is that there was an infection and anytime, there's an infection, particularly when there's this was a ventral hernias. This was this was a hernia repair from prior incision on the abdomen. Correct. Okay. And mesh was used which is very standard because without mesh the chance of the hernia coming back is, is very high. I would say unacceptably high particularly for eventual hernia. And so she had mesh place, which is. Very standard thing to do. And for whatever reason she got an infection and what usually happens is that because there's four and material in there. It's very difficult if not impossible for the patient's own body and own defenses to get rid of that infection. And so she had gone through a number of rounds of temps at trying to drain the infection and antibiotics. But the, the fact that there was permanent material in there just made it almost impossible for her body to get rid of that. Yeah. And Nancy, maybe you can enlighten us on the on what it was like from your perspective to have when you when you had that infection. It, it was just an open area that just wouldn't wouldn't hail. No wasn't necessarily eventually they became open..