No one can accuse Penn Medicine plastic surgeon John P. Fischer, MD, MPH and his team of underestimating what a hernia can do to a patient’s well-being. Dr. Fischer is Director of the Clinical Research Program, Division of Plastic Surgery. The Penn Hernia Repair Program clinical team wants to improve patients’ quality of life, and resolve the problems associated with hernias — specifically the incisional type which develops postoperatively.
Using Patient-Reported Outcomes to Reduce Hernias
The Penn Hernia Center’s Treatment Team — comprised of specialists in gastrointestinal surgery, plastic surgery, trauma, infectious disease and more — has been collecting and reviewing patient data to find answers to the quality-of-life issues affecting patients with hernia in an effort to reduce the number of these events.
“We are using and accessing our electronic health records, and harnessing the power of previously seen patients to better serve future patients,” he explained. “We want to understand the job we’ve done and how we can do better, and this has led to the development of a number of innovative tools here at Penn.”
Patients who do not have incisional hernia repair struggle with daily physical activities of life. To some extent, incisional hernias are avoidable, Dr. Fischer said. The causes of incisional hernia include: the method of abdominal closure; whether the surgery involves a bowel; and if the mesh was used to cover the original wound.
Chronic Hernias: Progressively Harder to Fix
“The public underestimates how great a problem a hernia can be,” said Dr. Fischer. “Small ones can become complicated ones. A combination of issues can lead to a failure in healing, which leads to other failures.’
It is important, he said, to stop minimizing the chronicity of these hernias. If an incisional hernia surgery is not performed correctly the first time, it becomes increasingly harder to correct surgically. By the third attempt, only 45% of cases are successful.
Using Technology to Advance Hernia Research
In 2017, Dr. Fischer and his colleagues reported on incisional hernias, using data from more than nine million discharges in the National Implant Sample between 2009 and 2013. Their goal was to find which disease states, if any, were most often found in patients who presented with hernias. The ultimate result of their research was an app. Incisional Hernia Prediction app lets the physicians determine their patients’ odds for developing an incisional hernia.
The clinical team have also developed ways to use new technology, including crowdsourcing, as a platform to evaluate lay perception of prophylactic mesh placement. The researchers wanted to gauge public perceptions of prophylatic mesh placement in open abdominal surgery, because another Hernia Program study demonstrated that mesh helps prevent incisional hernias.
Penn Hernia Center researchers also have investigated the corresponding rise of incisional hernias and mounting hospital charges.
The Hernia Repair program relies on a diverse collaboration of clinical teams. The principal treatment team consists of gastrointestinal surgeons, abdominal surgeons, trauma surgeons and bariatric surgeons, among others.
Dr. Fischer, himself, is a plastic and reconstructive surgeon.
As for how a plastic surgeon got involved with hernias, Dr. Fischer replied, hernia is defect in tissue. We are reconstructing a defect. We are trying to build a practice that is focusing to advance science and treatment. We are at the right place, right time. Plastic surgery is valued. And I enjoy these patients, and reconstructive surgery.”
Rehabilitative care at the Penn Hernia Center is focused on individualized patient care, and includes treatment from physical medicine and rehabilitation, physical and occupational therapy and pain management.
“We try to make sure that our repair is the last repair for the patient,” said Dr. Fischer.
When to Refer to Penn’s Hernia Program
Dr. Fischer wants primary care physicians with patients anticipating colon, cardiovascular, and urology surgery – any operation that could weaken the stomach wall – to do one thing: Discuss with the operating surgeon whether their patient is at risk for incisional hernia post-surgery, and if so, to refer to Penn's Hernia Repair Program for guidance and consultation. Penn's treatment team specializes in incisional and complex hernia repair and reconstruction.
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