WHEN HERNIAS IN THE ABDOMINAL WALL NEED SURGICAL REPAIR
General surgeons perform a wide variety of surgeries at Eastern Long Island Hospital. One surgery that is performed quite frequently is an abdominal wall hernia. Hernias happen when a body organ or tissue protrudes through a weakness or a hole in the abdominal wall which normally contains it. They most commonly occur in the abdominal wall and the organs that protrude are usually the large and small intestines.
Hernias can form in many areas—some of the more familiar ones are:
the groin (inguinal or femoral)
the navel (umbilical)
the breastbone (epigastric)
near an existing surgical scar (incisional)
People of both sexes and all ages get hernias. They frequently appear in middle age and the most common types are inguinal and umbilical hernias. About 2% of all adult males in the U.S. suffer from inguinal hernias, when the intestine bulges into the scrotum through the inguinal canal. Women get them too—in women, the intestine bulges into the canal itself. Nor are babies spared. Umbilical hernias are quite common and approximately 2% of infants, mostly boys, are born with inguinal hernia, sometimes on both sides. Heredity plays a part, particularly in men.
Abdominal hernias are usually caused by an inherent weakness in the abdominal wall that is present at birth. The hernia may not appear until the person is older and the abdominal muscles are weaker. Hernias also become evident after muscle damage due to heavy lifting, straining, coughing, pregnancy, or a substantial weight gain. Hernias caused by an injury to the abdomen are rare.
The first sign of a hernia is usually a bulge in the abdominal wall. Sometimes the protruding organ can be pushed back into place. There may be discomfort or even severe pain, particularly if the intestine becomes trapped and can’t slide back into place. When the blood supply is cut off to a twisted intestine, it is known as a strangulated hernia. This condition can lead to gangrene and requires immediate attention. In abdominal wall hernias, there is a weakness or defect in the fascial layer of the abdominal wall, which allows the abdominal organs to protrude. Once out of their normal position, these organs can become pinched or twisted.
The most common hernia symptoms are abdominal pain, nausea, vomiting, and an abdominal mass or lump which may come and go. Hernias are sometimes caused by previous surgical incisions, but can also occur without a previous surgery. Treatment for hernias is surgical repair. There are no exercises which can strengthen the tissues or any medications to take. Repair of the hernia is achieved by closing the defect in the fascial layer of the abdominal wall. A special synthetic material called a "mesh" is commonly utilized in repairing the defect in order to add extra strength. These procedures can be performed on an outpatient basis using local anesthesia and sedation. Depending on the site and location of the hernia, most patients are back to normal, non-strenuous activity in a few days. Never listen to anyone who tells you not to fix a hernia until it bothers you.
Talk to your surgeon if you feel you may have a hernia. This information is provided by Lawrence P. Kelly, MD, Chairman of Surgery at Eastern Long Island Hospital.
TREATMENT OPTIONS FOR BREAST CANCER
By Agostino Cervone, MD
When diagnosed with breast cancer, women should be aware of the types of treatment options currently available. Treatment options usually include some type of surgery in conjunction with radiotherapy or chemotherapy. In fact, surgery is the most common treatment for breast cancer, and there are several types, which can often be confusing.
One common type of surgery is breast-sparing surgery. This is an operation to remove the cancer but not the breast. After breast-sparing surgery, most women receive radiation therapy to destroy cancer cells that remain in the area. Both lumpectomy and partial mastectomy are examples of breast-sparing surgery. In lumpectomy, the surgeon removes the breast cancer and some normal tissue around it. In a partial mastectomy, the surgeon removes the cancer and a larger area of normal breast tissue around it. Occasionally, some of the lining over the chest muscles below the tumor is removed as well. Some lymph nodes under the arm may also be removed.
An operation to remove the breast or as much of the breast as possible is a called mastectomy. In most cases, the surgeon also removes lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system. This is called an axillary lymph node dissection. Breast reconstruction may be done later on, but it is often an option at the same time as the mastectomy. In a total or simple mastectomy, the surgeon removes the whole breast. Some lymph nodes under the arm may also be removed. In a modified radical mastectomy, the surgeon removes the whole breast, most of the lymph nodes under the arm, and, often, the lining over the chest muscles. The smaller of the two chest muscles also may be taken out to help in removing the lymph nodes.
In a radical mastectomy, the surgeon removes the breast, both chest muscles, all of the lymph nodes under the arm, and some additional fat and skin. For many years, this operation was considered the standard one for women with breast cancer, but it is almost never used today. In rare cases, radical mastectomy may be suggested if the cancer has spread to the chest muscles. Breast reconstruction (surgery to rebuild the shape of a breast) is often an option after mastectomy. Women considering reconstruction should discuss this with a plastic surgeon before having a mastectomy.
Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill cancer cells. The radiation may be directed at the breast by a machine (external radiation). The radiation can also come from radioactive material placed in thin plastic tubes that are placed directly in the breast (implant radiation). Some women have both kinds of radiation therapy. For external radiation therapy, the patient goes to the hospital or clinic, generally 5 days a week for several weeks. For implant radiation, a patient stays in the hospital. The implants remain in place for several days. They are removed before the woman goes home. Sometimes, depending on the size of the tumor and other factors, radiation therapy is used after surgery, especially after breast-sparing surgery. The radiation destroys any breast cancer cells that may remain in the area. Before surgery, radiation therapy, alone or with chemotherapy or hormonal therapy, is sometimes used to destroy cancer cells and shrink tumors. This approach is most often used in cases in which the breast tumor is large or not easily removed by surgery.
You will undoubtedly have many questions before having surgery including what types of surgery you should consider. A general surgeon can assist you in assessing risks and help you understand which treatment option is best for you depending on your diagnosis, make additional referrals for you, and assist you through recovery.
This information is provided by Agostino Cervone, MD, a board certified surgeon on the medical staff at Eastern Long Island Hospital.
ELIH MEDICAL STAFF FUNDS PET THERAPY PROGRAM 
Funded by the Medical Staff, Eastern Long Island Hospital Medical Staff introduces a popular pet therapy program to help behavioral health patients. This program is active in making patients feel positive and uplifted. “Dog owners across Suffolk County bring their pets to visit patients, and doing this not only makes patients laugh and smile, but is proven to lower blood pressure, reduce stress, improve fine motor skills, and stimulate patient communication and interaction,” notes Dr. David Roy Hensen, veterinarian, Program Director and member of the Patchogue Rotary Club. “The therapeutic benefits are already apparent. Witnessing the connection between the pets and the patients is very encouraging,” states Diane Van Velsor, Director of Activities Therapy. “Eastern Long Island Hospital is extremely grateful to the Medical Staff for their sponsorship of this very important patient centered program.”