St. Joseph’s Health Hernia Center of Excellence director discusses program, new accreditation
By Chris Motola
Q: St. Joe’s Health was recently accredited as a Center of Excellence in Hernia Surgery by the Surgical Review Corporation. What were the requirements? What’s the impact?
A: There’s an independent review committee that has a history of providing these accreditations. I know specifically for a long time it was bariatrics. That was a big thing and then they’ve extended or added on different accreditations that they offer to recognize different hospitals and actually give some outside review to what you’re doing at your hospital and hernia center accreditation is one of those things. We have a team. Danielle O’Brien [Hernia & Heartburn Center Program coordinator] has done a lot of work with some of the rest of us as far as filling out the application process. We needed a certain volume, a certain breadth of cases, including routine and complex hernias and then having the affiliated services, medical care, radiology and neurology.
There’s a number of other ones that we needed to have in the institution for backup and post-op care for some of our patients. So the Surgical Review Corporation reviewed that we had all of that and then looked at the volume of each of our surgeons to make sure we were doing the appropriate numbers. That’s kind of the gist of it. Some places, unfortunately, just call themselves a hernia center without the accreditation. This was good that we actually got the outside accreditation to validate what we were doing.
Q: What types of hernias do you treat?
A: We do everything. There’s really not much we can’t handle at St. Joe’s, between the surgeons we have. You know, we certainly do the largest volume in Syracuse of the routine hernias and those specifically are groin or inguinal hernias, belly button hernias and smaller hernias. And then we do up to and including complex abdominal wall reconstructions in patients who have had either a really complicated course after prior surgery or something unusually bad happens. Those people may have had very large hernias or they had some other medical problem that they couldn’t get it addressed earlier.
Q: Other than age-related issues, what are usually the common causes of hernias?
A: So, yeah, I mean, there are two subsets. There’s people who are born with them. Those are the ones that obviously show up as kids. We don’t do those at St. Joe’s, but in the general population is some combination of wear and tear and genetics and, like you mentioned, age. So people who are overweight, they have increased pressure in their belly, which can cause hernias.
And people who smoke or have asthma or other reasons to cough a lot are prone to getting hernias. And again, we think of smokers as kind of the prototypical one of those, because again, they increase the intra-abdominal pressure and that causes hernias. And then kind of the last thing is wear and tear. People who are laborers, construction workers, that sort of stuff, accumulate stresses just from doing their jobs. And then as we get older, to your point, all of that accumulated stress and wear and tear adds up and you can get a hernia. Just like some people get worn out knees or hips or joints, other people get hernias. At times, yeah, it’s not a specific thing; it’s all the things you’ve done over your lifetime, typically.
Q: As far as outcomes from the surgery, sometimes there are issues with the meshes causing pain down the road. Is that something that can be prevented at the time of surgery?
A: Yeah, we get that question a lot. Certainly I do. I would say half of the people who get probably more than that ask about the mesh. So that’s a common question for groin hernias or inguinal hernias specifically. If you’re going to get some type of thing, it tends to be just more from having groin surgery. You can get groin pain from having the surgery from the mesh.
We do a lot of robotics now, which does decrease the risk of that. There are no intra-abdominal complications from those meshes. It does tend to be related to the scarring from the mesh, that it can entrap one of the nerves. To try and fix that, there’s a number of stretches that we recommend to people. It very rarely goes to the fact that we need to take the mesh out. It’s very, very rare that we need to do that. There’s a number of physical therapy things that we can address to loosen up the scarring around the nerves to stop that pain or discomfort that some people get. And then with the belly button or abdominal wall hernias, the meshes are a lot more resistant to scarring and causing complications from the mesh eroding into things like it used to. The mesh that we have at St. Joe’s does have a protective coating on the back of it. It doesn’t completely eliminate scarring or scar tissue from forming to it, but it dramatically reduces it. As far as some of the meshes from the ‘90s and early 2000s that used to very aggressively erode into things, it was a problem. But thankfully, it’s not a big deal these days.
Q: To what degree does physical therapy either ameliorate the need for surgery or help recover from it?
A: Unfortunately, for patients, there’s no physical therapy that can eliminate a hernia. Once you have it, you have it. You can strengthen the tissue around it, but once the defect is there, it’s there and it’s only going to get bigger with time. But as far as recovering from surgery, before and after, very simply, the stronger you go into surgery, the better you’re going to come out of it. So I certainly want people active going into surgery if they can tolerate it and aren’t having much pain. After surgery, we can typically get people back pretty to normal quickly, depending on if it’s a normal-sized hernia, as we define it anyway, a relatively small hernia. People only have downtime of a couple of weeks where they can’t lift or strain. But they can walk, do stairs, all light activity immediately after the surgery. So it’s usually not as big of an impact in people’s lives as they think or they worry about.
People with really heavy lifting at their jobs or something still may be out a month or so. A typical example is a construction worker or something like that that has to really strain and lift day to day. But most people can get back to their jobs pretty quickly and can exercise pretty quickly after the surgery.
Q: And how much follow-up is usually needed to kind of keep an eye on things after they’ve recovered?
A: For typical hernias, at least in my practice, most people it’s one post-op visit and that’s it. About 10 to 14 days after the surgery, we make sure that they’re feeling fine. Most people are relatively pain-free at that point. Just some mild soreness. If everything is as expected at that post-op visit then typically, there’s no scheduled follow-up after that. If there’s any complication, if they’re having lingering pain like we alluded to before with the groin hernias and that sort of thing more, we’ll do follow-ups for sure. For the larger more complicated hernias that I do typically there’s the immediate the 10 to 14 day follow-up then a month later and usually three months after that.
LIFELINES
Name: Travis P. Webb, M.D.
Position: Medical director of the Hernia Center of Excellence at St. Joseph’s Health
Hometown: Westmoreland
Education: SUNY Buffalo (Jacobs School of Medicine and Biomedical Sciences)
Affiliations: St. Joseph’s Health Hospital
Professional organizations: American College of Surgeons.
Family: Wife, three kids.
Hobbies: Exercise, bike riding