Weighing in with Bariatric and Hernia Surgery

In general, a hernia is an internal body part, organ or part of an organ that protrudes through an weakening in the abdominal wall. This will often appear as a soft bulge through the skin. This bulge can often be easily pushed back through the opening. The bulge may be more apparent while lifting a heavy object, laughing or coughing. Some hernias are painful, but most are not. There are several different types of hernias, including:

• Hiatal
• Incisional
• Umbilical
• Inguinal

Hiatal Hernia
This type of hernia occurs when part of the upper stomach protrudes through the hiatus, which is an opening between the chest and the abdomen. The esophagus, the tube connecting the mouth and the stomach, passes through this area. In a sliding hiatal hernia, part of the upper stomach bulges upwards into the chest area through the diaphragm, a muscle involved in breathing. Symptoms include:

• Burping and bloating
• Chest pain
• Heartburn
• Nausea
• Shortness of breath
• Backwash of stomach contents into the mouth

Hiatal hernias are more common in women, people over 50 and people who are overweight. Not all symptoms of heartburn and stomach upset are due to hiatal hernia. If you have the above symptoms, you may need to have them evaluated by a general surgeon.

Inguinal Hernia
An inguinal hernia pushes through a hole in the abdominal wall near an area by the groin called the inguinal canal. Both sexes have this structure. A hernia of this type will cause a bulge to appear through the skin near the pubic area or top of the thigh. This bulge may get bigger when you cough, laugh or bend over. This kind of hernia may be painful. Other possible symptoms include a feeling of heaviness or burning sensations in the inguinal area. Men may notice swelling of the scrotum. More men than women have this condition.

Umbilical Hernia
This kind of hernia is a protrusion through a hole near the navel. This condition mainly occurs in babies and small children, but anyone can get one. During pregnancy, the fetus’s umbilical cord passes through an opening in its abdomen. This hole normally closes shortly after birth. When it doesn’t, a soft lump near the navel may be noticed. Most of these hernias are painless, and the vast majority will disappear without treatment by the time a child is three to four years old. Umbilical hernias persisting after the age of five will likely need surgical repair.

Incisional Hernia
As the name suggests, an incisional hernia occurs at or near the site of a previously healed surgical incision. This is usually because the incision failed to close properly after the initial surgical procedure. This happens in approximately 15 to 20 percent of surgeries. These hernias generally occur between three and six months after surgery, but they can happen at any time.  Possible symptoms include:

• Fever
• Aching in the area
• Nausea
• Diarrhea or constipation
• Pain around the incision site

Certain factors increase the odds of an incisional hernia, such as wound infection, putting pressure on the incision too soon, certain medications, obesity, smoking and certain health conditions like diabetes.

Treatment
Not all hernias will require treatment. Some are small and not painful and can simply be watched. However, a hernia can become strangulated or incarcerated. This means that it’s caught in the hole in the abdominal wall and is stuck. If you notice sudden pain and that the protruding area has turned red or purple, seek medical attention immediately.

Hernias requiring surgery are typically treated with a laparoscopic procedure that uses very small incisions to access the hernia and close it. Recovery is generally fast and entails little discomfort. If you think you have a hernia, contact a Miami general surgeon.

Weight Loss and Health
Being overweight increases the chances of diabetes, heart disease, high blood pressure, high blood cholesterol and joint disease. It’s also socially unacceptable to be heavy. This can cause emotional and psychological problems, too. While it’s probably best to lose weight through diet, exercise and lifestyle modification, not everyone is able to do this. This is especially true for the morbidly obese, who are often hundreds of pounds over any kind of reasonable weight. There are medications that help some people lose weight, but these have side effects. Some aren’t intended for long-term use. None treat the underlying problems that caused the obesity in the first place. Someone who is obese, especially if they have other medical conditions like diabetes or sleep apnea, can consult with a bariatric surgeon.

Body Mass Index
The body mass index, or BMI, is a measurement of weight. It’s also a tool used by a bariatric surgeon. This kind of surgeon specializes in surgical procedures that help people to lose weight. Bariatric surgery works by limiting caloric intake. This also limits nutritional intake, so some types of bariatric surgery, but not all, are typically reserved for those with a BMI of about or more than 40. A BMI of 35 is considered if other serious health conditions are also present, such as diabetes or heart disease. However, your bariatric surgeon is the only one who can decide if this kind of surgery is right for you. There are surgeons in this specialty conveniently located in Miami.

The BMI is calculated by a person’s height and weight. A BMI of 18 to less than 25 falls into the normal range. If you would like to calculate your BMI, you can use this table.

There are a number of bariatric procedures. Not all are surgical. Some of them are associated with a dramatic improvement in blood sugar levels in diabetics.

Orbera Intragastric Balloon
Under sedation, a special kind of balloon is passed through the mouth into the stomach. The balloon is then filled with a salt solution until it’s about as big as a grapefruit. Over the next six months, the presence of the balloon will limit the intake of food. Even more important, it will help the brain learn to interpret new feelings of satiety, or the feeling of being full. This procedure is reversible and may result in weight loss of 20 to 50 pounds.

Sleeve Gastrectomy
This is the most common surgical bariatric procedure performed for weight loss. It involves turning a portion of the stomach into a sleeve-shaped object, hence the name. The stomach is not able to hold as much food. The procedure also causes hormone changes that affect the way the brain signals the body to indicate that enough food has been ingested. This procedure is minimally invasive, does not involve the intestine and does not leave a big scar. It typically produces significant weight loss within the first year.

Gastric Bypass
Not as commonly performed as it once was, the procedure involves stapling a small portion of the stomach closed. This creates the new stomach area, which can only hold a small amount of food at one time. This reduces caloric intake. The intestines are also rerouted, further reducing the intake of nutrients and calories. Gastric bypass typically results in drastic weight loss within the first year. It’s performed using minimally invasive surgical techniques, leaving no large scar.