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April 4, 2020

Providing Excellent Surgical Care- Dr. Erik Lough Discusses General Surgeries and Hernia Repair

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here with my incredible cohost, Donna Lee.

Donna Lee: 

That’s me. Hey, I have a joke. Why do millennials only count in threes?

Dr. Mistry: 

Why?

Donna Lee: 

Because they can’t even! Sorry. Go ahead.

Dr. Mistry: 

That was terrible.

Donna Lee: 

Tell me how awesome I am.

Dr. Mistry: 

You’re great.

Donna Lee: 

Thank you.

Dr. Mistry: 

You’re great. We’ve been doing this show for almost a year now.

Donna Lee: 

Has it been a year?

Dr. Mistry: 

Yeah, almost. We’re getting incredible feedback. Really appreciate all the support we’re getting with people…

Donna Lee: 

On the podcasts.

Dr. Mistry: 

…listening to the podcasts.

Donna Lee: 

We got like 500 downloads in a week!

Dr. Mistry: 

It’s blowing up, it’s blowing up now.

Donna Lee: 

We’re super famous, but not famous at all.

Dr. Mistry: 

Yes. And we’re award-winning.

Donna Lee: 

We are.

Dr. Mistry: 

Although we gave the award ourselves. We’re really lucky today. Today we have a special guest. That’s right.

Donna Lee: 

We’ve had some awesome special guests, but this one is super special.

Dr. Mistry: 

That’s right. That’s right. And if you’ve listened to the show, you know that my favorite guests are always surgeons.

Donna Lee: 

And you’d like to give them crap…

Dr. Mistry: 

I do like like to give them crap.

Donna Lee: 

…about where they went to school.

Dr. Mistry: 

I do. I do.

Donna Lee: 

And gow big their phone is.

Dr. Mistry: 

That’s funny.

Donna Lee: 

How big their hands are.

Dr. Mistry: 

So today we have Dr. Erik Lough. Erik, thanks a lot for joining us today.

Dr. Lough: 

Yeah, you’re very welcome. Thank you.

Dr. Mistry: 

Dr. Lough is a general surgeon with Capitol Surgeon’s Group here in Austin, and most importantly, my go-to guy. When I’m in trouble…

Dr. Lough: 

Thank you.

Dr. Mistry: 

…he’s the one I call.

Donna Lee: 

I heard.

Dr. Mistry: 

He’s the one I call.

Donna Lee: 

He’s the one that we send lunch to randomly, when you tell me to.

Dr. Mistry: 

That’s right. That’s right. You know that when I come home and it doesn’t look like it’s been a good day for me and I say, please get Dr. Lough’s office lunch, you know that something happened and he had to come bail me out. Thanks a lot for always being there for me.

Dr. Lough: 

My pleasure. Anytime.

Dr. Mistry: 

A lot of times the general public may not know what kinds of things a general surgeon takes care of versus a specialist, and I thought maybe you could go through just a couple of things that make up the majority of your clinical volume.

Dr. Lough: 

I always tell people, essentially what I do is hernia and reflux and obesity, and a general surgeon can take care of pretty much anything within your abdomen–so your stomach, your small intestine, your large intestine, hernias, and then anything that leads to gallbladder problems, you know, problems with your appendix, we do emergency appendectomies, people get appendicitis, people that have severe heartburn or hiatal hernia, we can do the surgery to stop the reflux from happening, because the stomach is part of the gastrointestinal tract. We do operations on the stomach to do weight loss for people.

Dr. Mistry: 

So you’re being very modest. I mean, the truth is is that general surgeons are bad asses and they can…

Dr. Lough: 

We can do things in general.

Dr. Mistry: 

We can do things in general. I mean, you train in a way in which you can take care of, you know, gunshot wounds to almost any part of the body.

Dr. Lough: 

Right.

Dr. Mistry: 

You can take care of masses of the head and neck. It may be the case that there may be specialists that do that also.

Dr. Lough: 

Yes, true.

Dr. Mistry: 

But as a general surgeon, your training is really head to toe. When I was in my general surgery, we took off toes!

Dr. Lough: 

When I was a resident, you know, we would do trauma. So, like you said, anything that happens from violence like gunshot wounds or stabbings, people getting in car accidents, falling off the scaffolding at work, breaking some bones, and we just sorta can stabilize that thing. We did vascular, so people that got blockages in their blood vessels, like you said, head and neck, thyroid surgeries.

Dr. Mistry: 

If you live in Austin, you may notice that there’s a bunch more trauma hospitals and trauma ER’s all over the place, not just, you know, University Hospital at Breckinridge. Our listeners may not know there’s a general surgeon, a 40 year old man with kids and a wife, who has to sleep there just in case you get in a car accident.

Dr. Lough: 

Yes, I’ve got to be in the ER in less than 15 minutes if you show up.

Dr. Mistry: 

And they sleep there. And it’s always fascinating to me that, you know, I thought that those days would be over in residency, and my poor colleagues are there all the time, ready and waiting to save your life if something happens to you. And saved my life.

Donna Lee: 

Don’t go to sixth street.

Dr. Mistry: 

So, not always life-threatening is the issue of hernias. Hernias are extraordinarily common. There’s all sorts of different hernias. When it comes to any type of hernia, I usually send them to you to get repaired because you fix it in a number of ways. Maybe you could talk generally about the most common types of hernias and what kind of symptoms people might have.

Dr. Lough: 

The hernia is essentially a opening in the wall of your abdomen. So you can think of your abdomen being enclosed by a layer of muscle. And that’s the wall. If there’s a hole in the wall, something from the inside can poke through it. And so people would see a bulge sticking out or something sort of getting squeezed, either in their belly button region, which is called an umbilical hernia or in their groin region, which is called an inguinal hernia. And, I always tell people with inguinal hernia, the one in your groin, basically where you know the way our bodies are made, we have a little muscular canal down in the groin. If you were a man and you were in your mother’s womb when you were developing, your testes were inside your belly and they traveled down that canal down into your scrotum before you were born. And then later on in life, something else can try to follow the path that that testicle took and poke through that canal. And so you’ll look down in your groin and you’ll see a bulge near the genital region. And it’s usually looks strange in the mirror. It can hurt when you’re sitting or lifting. And so people usually start wondering what the heck is that? And they start to find treatment for that hernia.

Donna Lee: 

How would you know though to go to a urologist versus general surgeon for that?

Dr. Mistry: 

That’s a great point because as a urologist, oftentimes people complain of lower groin or testicular pain.

Dr. Lough: 

Sure.

Dr. Mistry: 

And I’ll diagnose the hernia. And sometimes they’ll come to you because they think they have a hernia because they have testicular pain, and you have to send them to me because they don’t have one.

Dr. Lough: 

Yeah, it’s something else.

Dr. Mistry: 

And both umbilical hernia, or the belly button hernia, and the inguinal hernia–those holes or that weakness in the muscular lining is our natural weaknesses…

Dr. Lough: 

Yep, it’s part of being a human.

Dr. Mistry: 

…that are just being exploited. And so that’s why, as you get older, those natural openings or natural weaknesses are going to get bigger. And so that’s why with age you’re more likely to get some of these things. Also if you’ve had surgery, right? That also causes an opening.

Dr. Lough: 

The ones that you can get without any surgery, the ones that were basically born with the risk of, is the belly button hernia or the groin hernia. If you’ve ever had any operation, especially by a general surgeon to do something inside your belly, the surgeon made an incision in that muscle wall. We sew that hole closed with suture, if it heals perfectly well the hole in the wall is closed back up. But if like the factors you mentioned–age, a lot of strenuous activity, weight gain, anything that puts pressure on that abdominal wall–that incision that was previously healed in the muscle can gradually start to widen open again. Now you’re back to a hole in the wall and something can push through it and that’s your incisional hernia.

Dr. Mistry: 

So as a general rule, when you’re fixing these things, you do something to shove back whatever is poking out, whether it be intestine or whatever organ, and then you put like a patch on it so that, just like you’re just kinda putting a patch on a wall, just using your analogy. And that can be done open or laparoscopically. And you’re the king of laparoscopy…

Dr. Lough: 

We do it laparoscopically. Absolutely.

Dr. Mistry: 

Maybe you could tell me what are some of the benefits of the laparoscopic approach? What should people look for in their doctor when they’re trying to get a hernia looked at?

Dr. Lough: 

A lot of people will see me and they think I’m cutting out their hernia. So they see this bulge sticking out and they think that I’m going to cut that bulge out of them. But really what they’re seeing is the thing on the inside that’s pushing through the hole. So what we want to do is get onto the inside of your abdomen and pull that thing back in where it belongs, sew the hole closed, and patch it. So I always tell people with a laparoscopy, it’s a much better way to see everything inside the belly. So I can get in there with my camera and look up at the hole and basically get the worm’s eye view of whatever is poking up through the hernia. And then I can use my instruments to bring it all back in safely, delicately, keep it intact the way it should be. And then I can use my suture and needle and sew the hole closed, but from the inside. And then we roll up the mesh real tight, slide it in through one of our incisions, and then we unroll it on the inside and put it directly behind that. And it’s basically a reinforcement to one, keep the sutured muscle closed the way it should be and two, it’s sort of laminates your abdominal wall. So we laminate things to make things stronger, you know, like plywood and you know, laminating sheets of things.

Dr. Mistry: 

It makes it stronger.

Dr. Lough: 

So it’s like laminating your wall. And then your collagen can kind of grow and weave into that material and really strengthen the closure that you’ve done. If you do something open, you basically have to cut directly over top of wherever the hernia is located, push it back in from the outside, and then try to get your mesh to get into that hole. Sometimes you can close it, sometimes you can’t close it. If you do it laparoscopically, you’re talking about a 5 millimeter incision, an 8 millimeter incision off to the side, sort of farther away from where the hernia actually is located. And then you definitely know you’ve got everything inside, after you’ve done the resection, because you can watch the whole from the worm’s eye view.

Dr. Mistry: 

If somebody is going to get one of the most common ones fixed, like the umbilical hernia or the inguinal hernia, how long does that surgery generally take and what can people look forward to in terms of recovery?

Dr. Lough: 

That’s the beautiful thing about laparoscopy, and even now robotic surgery. We, you know, general surgeons are really embracing the use of the robot to do inguinal hernia repair specifically, which is the groin hernia. You can do a single sided–like if you just have a hernia on the right side–you can do that in 45 minutes. It’s a same day surgery. So the person comes to the hospital, gets the surgery done, goes home the same day. And they got three eight millimeter incisions, sort of at the belly button, and then one on either side. If they have a bilateral hernia, which is a hernia on the right and the left, it probably adds another 20 to 30 minutes onto the case, and now you’re looking at 90 minutes. But the good news is you’re still doing the whole surgery through those same little 3 incisions. So if you did an open inguinal hernia…

Dr. Mistry: 

You’d get 2 six centimeter incisions.

Dr. Lough: 

…you’d get to have to cut open over the right side and fix the whole thing and then sew it up and you’re done, and then start all over again and make a new cut on the left side and start all over. But you can do a robotic bilateral hernia through the same 3 incisions, you just turn the camera a little bit to one side and you keep on going. But then, yeah, you go home the same day. People are walking around immediately. And then I tell people at least for the first 2 weeks, just kinda take it easy. Do all the normal stuff you do around the house. Go to the grocery store, sleep in your bed, go to work if you want if you don’t pick up anything too heavy, great. And then I usually see people about the 2 week mark back, and those little cuts on their belly are healed up and I say, “I’ll see you whenever you need me. Hopefully you don’t need me anymore!

Dr. Mistry: 

Well, that’s great. Thank you so much for joining us today, Erik. You’re just an incredible surgeon and an incredible friend of this practice and we really appreciate everything you do.

Dr. Lough: 

Thanks, likewise.

Dr. Mistry: 

If you have questions for Dr. Lough or for us, how do people get ahold of us?

Donna Lee: 

They can call us at (512) 238-0762. We have to go to commercial. We’ll be right back.

: 

The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.

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