What if we know something isn’t quite right with our body? Even if nothing hurts?
Jay Couch, a manager at a Lowe’s Home Improvement store in Supply, North Carolina, had occasional mild abdominal discomfort, but it really didn’t seem like anything. “The only hint something was wrong was visual,” he said. His belly button “had gone from an innie to an outie. If I pushed against my navel, I could feel a hole there.”
It wasn’t even worrisome enough to schedule an appointment with his primary care doctor. But when he was at her office for a routine visit, he mentioned it. She referred him to Dr. J. Andrew Smith, a general surgeon with Novant Health Surgical Associates in Bolivia, North Carolina.
The doctor explained that Couch, 49, had a hernia, an organ bulging through the muscle wall that surrounds it. You can get a hernia from heavy lifting, persistent sneezing or coughing, pregnancy or constipation. Common symptoms include bulging or firm masses in the groin or abdominal wall, pain and, in severe cases, nausea and vomiting.
While hernias may be discovered during a CT scan or MRI, the best screening test is a physical exam. Hernias are common, and minimally invasive surgery is almost always required.
“Surgery is the definitive and only effective treatment to correct a hernia,” Smith said. “However, it is not uncommon to observe a hernia (in the early stages), particularly if it’s relatively small and not causing discomfort.”
Couch’s was not causing him pain. “I lead an active lifestyle,” said Couch, an avid hunter, fisherman, weight lifter and motorcyclist. “And this diagnosis came during my busiest season at work. I didn’t want to be out of work for an extended time. I told Dr. Smith it would be six months before I could have the operation.”
It’s generally OK to wait. “Most hernias can be repaired electively,” Smith said. “However, hernias that are … becoming painful are often best treated sooner rather than later to avoid complications. A hernia becomes an (emergency) situation when it … contains internal organs which can be compromised by lack of blood flow to the organ.” This usually causes significant pain and often results in an ER visit.
Couch needn’t have waited until the fall of 2019. “It was a same-day operation,” he said. “I got there in the morning and was out by 3. And my recovery time was practically nothing. I was down for 24 hours and tender for 48 hours. If I coughed, I could feel it in my abdomen. I probably could’ve gone back to work after a week off, but I had saved up my vacation time and took the full two weeks Dr. Smith advised.”
He didn’t need any pain meds after his second day following the surgery.
“It was miraculous,” Couch continued. “I know someone who had similar surgery and needed to be out for six weeks. I attributed it to my doctor. He brushed it off and said it’s the technology.”
In this case, the minimally invasive surgery was made possible by the da Vinci Surgical System, a form of robotically assisted surgery. It’s worth noting that the word “robot” can be misleading. The surgeon uses the da Vinci system to perform the surgery without making a large incision you often see in traditional surgery.
“The da Vinci robot … allows us to close hernia defects through very small incisions as well as place hernia mesh precisely and with less painful methods than other approaches,” Smith said. “However, it’s not always the right choice. Any patient interested in exploring options for hernia surgery should see a surgeon.”
Couch is a fan. “If I’d believed how quick the recovery time would be, I’d have had this surgery months before I did,” he said. “I was expecting the worst and got the best.”
“I’m feeling better than I have in years,” he said. “My job requires me to lift, stretch, bend and stoop, and I’m doing all of that without any discomfort now. I’m able to be even more active at the gym.”