The Get Healthy Tampa Bay Podcast

E115: We're Back With Dr. Jenna Kazil To Talk About HERNIAS đź‘€

• Kerry Reller

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Welcome back to the Get Healthy Tampa Bay Podcast! This week is Part 2 of our conversation with Dr. Jenna Kazil, a double board-certified vascular and general surgeon based in Bradenton, Florida.

In this episode, we pick up our discussion on hernias—diving deeper into how they form, how to recognize the warning signs, and what treatment options are available. Dr. Kazil breaks down the differences between types of hernias, including inguinal, umbilical, ventral, and incisional hernias, and explains why men are more commonly affected.

We also explore how hernias are diagnosed, when surgery is necessary, and the pros and cons of different repair methods—especially the benefits of robotic surgery and mesh use. Plus, we cover common concerns like mesh safety, recurrence, and how to prevent hernias through proper core strengthening and movement techniques.

Whether you’re dealing with a hernia, recovering from surgery, or just want to understand your body better, this episode is packed with practical insights and expert advice. Tune in and take one step closer to a stronger, healthier you!

Dr. Jenna Caporaso Kazil is a double boarded general and vascular surgeon who works in Bradenton and Sun City Center, Florida. She has won multiple awards including the people’s choice award as well as physician of the year. She is the current vice chief of staff and former chief of surgery at HCA Florida Southshore Hospital. She enjoys robotic, open, and endovascular cases, doing a wide range of procedures. When she isn’t caring for patients, you can find her at the beach with her eight-year-old twins.

0:28 – Picking up where we left off: What is a hernia, really?
0:51 – Different types of hernias: Inguinal, ventral, umbilical, and incisional
1:31 – What to watch for: pain, bulging, and other key symptoms
2:36 – Why men are more prone to inguinal hernias
3:07 – When hernias involve bladder or bowel issues
3:47 – Hernia causes: lifestyle, genetics, and abdominal pressure
4:23 – Diagnosing hernias: physical exam vs imaging
5:36 – When hernias become urgent or emergency cases
8:44 – Surgical options: open repair, mesh, and the benefits of robotic surgery
14:46 – Prevention tips, diastasis recti, and protecting your core

Connect with Dr. Jenna
Website: Website: www.floridasurgicalclinic.com

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Kerry:

Hi everybody. Welcome back again to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and we have our expert vascular and general surgeon, Dr. Jenna Kazil back with us today to discuss hernias. And since we just had a recent episode with you, I think we'll save that introduction for next time. But why don't you tell us, you know what are hernias, and let's just start with it.

Jenna:

So hernias are typically a break in the fascia, which is the connective tissue of our abdominal wall, and you can have those in any number of places. There's also something called an internal hernia, like a hiatal hernia where you have essentially things that. Aren't, aren't where they belong. They can get stuck in, in different places due to a laxity in tissue. But the hernias we're talking about today are gonna be abdominal wall hernias. So that's everything from inguinal hernias, ventral hernias, incisional hernias things like that.

Kerry:

Okay, and so what are some signs and symptoms that once someone might think that they have something wrong and it could be pointing toward a hernia?

Jenna:

The most common one is gonna be a bulge. So especially in men, they're gonna have a bulge in their groin, usually right near their testicle or the base of their penis, and it's gonna be, usually it's pretty painful, and over time it gets bigger. Sometimes it's not painful, but it gets. Bigger and bigger and bigger. Usually you can push it back. In women, you can have just some groin pain that you can have a large bulge as well. You can also have a, an umbilical hernia, so. People say they've had an an any for their entire life and now all of a sudden they have an outtie. And a lot of times I can very easily palpate that they have a fascial defect there from a small hernia. The other type would be a ventral hernia. So anywhere in your abdominal wall, anywhere along your abdominal muscles, you can have this bulge or pain. That can be a hernia as well. And then finally, we talked about incisional hernias. So maybe you had your appendix out when you were a kid or you had a gallbladder surgery and now under one of your incisions you have a bulging or or painful area.

Kerry:

So why more men more than women for the inguinal hernia?

Jenna:

So that has to do with really how we're all created in utero. So the testicles start as an intraabdominal organ and then over time before babies are born, they proceed to the outside world and end up in the scrotum. And so you form this tract and that can stay open and that would be a patent processes vaginalis. And so this area is a little weaker and tends to form hernias more so than women, which you know, are always stay within our bodies our entire lives.

Kerry:

So what, what are the signs and symptoms of having a hernia?

Jenna:

Pain bulging. Those are the big ones. Sometimes patients will actually have parts of their bladder or even their colon stuck inside their hernia, and so then they'll get problems urinating or they'll have problems going to the bathroom in general. And those are, are usually much larger, more symptomatic patients.

Kerry:

And so what ex, so the hernia you said is like the breakdown of the fascia, but there's usually an outpouching of, you know, abdominal contents, is what we're talking about is for like the risk factor of when there's more pain. Right. Okay.

Jenna:

That's the hernia sac.

Kerry:

Okay. And how how has it typically caused, like, what causes the hernia to develop?

Jenna:

You know, it can be a, again, I think there is a genetic component to this, and sometimes patients will say, yeah, my, all of my siblings have had hernia repairs, my parents had hernia repairs. You have collagen defect. So an ehlers danlos kind of thing, which is obviously much less common. But a lot of it is lifestyle. Or you say you're a, a construction worker or you're a weightlifter, things like that may put you at more risk as well, so sudden heavy bouts of of intraabdominal pressure can cause the hernias.

Kerry:

And well, how do you kind of diagnose it? Or how does that,

Jenna:

So for me, typically I'm looking at the patient and if I can look at a patient and see a bulge or feel a bulge, I'll actually put my fingers into the inguinal canal and feel this bulging sensation or a, a loosened area. And if I can feel that I don't really need anything else. Sometimes, especially with incisional hernias, you can't really tell how big it is, or you think it's a particular size, but it makes it more challenging. And I'll get a CAT scan and that's gonna show me exactly where the fascial defects are.

Kerry:

Is there any imaging to do for the inguinal hernia or just clinical?

Jenna:

if you can't tell. If I can tell and I know exactly what it is, I don't get any imaging. Sometimes, you know, from a diagnostic perspective, patients will come in and they'll say, well, I had an ultrasound. The ultrasounds to me are very tech dependent and I really wanna see those images. And I feel like if you're gonna get a, an imaging, I'd rather just get a CAT scan.

Kerry:

Mm-hmm. Okay. So patient comes in, they're having like pain and bulging in there. And you mentioned the risk factors for more like, more serious thing is how about like, is there a concern for bowel obstruction or anything like that?

Jenna:

There can be. So, you know, if you can push them back and I'd say the majority I can push back, that's called a, a reducible hernia. I'm really not worried. And those need to be fixed, you know, if they're bothersome, I. Soon. Now, soon could be a couple weeks. It could say, I could say, well, you know, you really need to see your cardiologist because you've had heart stents and we really need to make sure that you're healthy enough to do any sort of procedure. That might be a month or two. But if they're stuck or if they can't go to the bathroom, then that becomes a much more concerning problem. And certainly if they can't go to the bathroom and they're completely obstructed, which would mean. If they're not passing gas, they're not having bowel movements, they might even be throwing up. Now that's an emergency where that patient's gonna go to the emergency room and then we're gonna take them immediately to surgery.

Kerry:

So you've got emergency surgery and then I'm assuming, you know, the rest of them could be more elective decisions.

Jenna:

and some patients have really tiny hernias, and a lot of times I'll see these patients and they come in and they have, you know, a less than one centimeter, so less than half an inch belly button hernia that their primary care doctor found'em, and they have zero pain and they're, they're freaking out. I'm like, well, what's gonna happen? And I need this fixed right this minute. Like, well actually, if you have zero pain and it's very small, you don't need to do anything. The VA actually did a great study on thousands and thousands of patients with small inguinal hernias. And so, you know, when we say small, we we're kind of talking about two different things. So first you have the defect in the abdominal wall itself, and then you have the, size of the hernia sac. And what I think some patients, and even primary doctors get confused is they'll say, well, it's a really large hernia, so the defect may be very small and the sac might be super large, and that doesn't mean that it's a large hernia. It might be very symptomatic, but the hernia defect itself is quite small. The smaller, the defect with the larger the sac in my opinion, makes the, the procedure much more challenging and is more likely to incarcerate. When you have these patients that have these very large hernia defects and very large sacs, things can fully go back and forth. It's much less dangerous. But the, the VA did a study and had these patients with small hernias, and after a year or two the patients who had surgery, didn't have surgery, had the same amount of pain. They were relatively asymptomatic, but. Most of my patients that I see over time, they get progressively worse. They get a larger hernia and they end up needing a procedure. So I may not do the patient, I may see them, let's say I see them today, you know? Yeah. You know, I did have some pain. The pain got better. Do I have to have? And I go, maybe you don't have to have it right now. And I'll see them back in six months and they're like, well actually it's gotten bigger and it's more painful and I want it fixed. And that's fine. These typically aren't emergency procedures.

Kerry:

So how, how do you know what the sac size is and the defect size is prior to actually doing its procedure?

Jenna:

you don't, sometimes you have no idea. Sometimes you can see it on CAT scan. Most of this is all by physical exam, so I can tell just putting my fingers in the inguinal canal how large that is.

Kerry:

So what are the ways that you can operate and fix the hernias? What are the different ways?

Jenna:

So typically people will do this open, so we'll make a, a cut into the abdomen or into the groin somewhere. And for, so for instance, for inguinal hernias, you're cutting out the sac and sewing that up and that a long time ago, 75 years ago, that was it. That was the repair. You would cut out the sack, you, you put some sutures in. You would try to sort of over sew some of the muscles and call it a day. And those don't work that great. There are still some people who do these, these over sewing types of repairs. And I think that there's. Indications, but you really need to talk to your surgeon about why you would do that. I think now, for the most part, the gold standard is gonna be a mesh repair for any hernias, certainly any ventral hernias. So any abdominal wall hernias, more than two centimeters. And I'd say for most inal hernias, people are using meshes as well. So the way that I love to fix these is on the robot, and there's a couple different reasons why I like to do the robot. For inguinal, there's really three different. Sites and the inguinal canal anatomy is really extremely detailed and complex. But if you think about it like a triangle, so here's our triangle and we have direct, indirect, and, and femoral components. And so what I can do is I can pull that all of that hernia sac back into the body and then lay a mesh over the entire triangle. And so now that area is no longer gonna form hernia because it's covered with the mesh. Okay. And that's really my favorite reason to do it that way. The other reasons why I think are great on the robot one, you can tell for sure, you can put a camera in there and you can see, is this really a hernia or not? Because you can see the outpouching and the defect but also the decrease in pain and the improved recovery time. Typically for an open inguinal hernia repair, they might have an incision that's, you know, anywhere from three to five inches. And they're gonna be in pain and have kind of, you know, hard time walking. Sometimes they're gonna need some narcotics usually, and they're gonna have that for. Two to six weeks of, of kind of just being sore. Not the end of the world. But patients don't really like that. Whereas my robotic patients are only sore for a couple days. I don't give any narcotics and they're usually back to doing normal activities. Even things like the gym and things like that, anywhere from two to four weeks, depending on what I'm fixing. That's for inguinal ventrals. I usually make them wait a little bit longer.

Kerry:

So the robot definitely has better recovery time, which is, you

Jenna:

A hundred percent. A hundred percent. The robot can be kind of challenging for incisional hernias because with incisional hernias, typically things are getting stuck in there. Everything's really sticky. And that can be a little more challenging depending on what's going on. And sometimes I'll, I'll just say, you know, this isn't the best option for this patient once I get in there and I have to convert to open and there's nothing wrong with that. But especially these, you know, smaller ventral hernias or an umbilical hernia that's maybe three or four centimeters, that's a great case for the robot. I think you get a really great repair. It looks really pretty. On the outside you can recreate somebody's belly button. And I think it's a really great way to do it.

Kerry:

Do adhesions from prior surgeries make things more complicated when doing the.

Jenna:

it can. And sometimes you get these really filmy they almost look like cellophane, like adhesions. And sometimes everything is just so gosh darn stuck. You can't see a darn thing. And, and that becomes a problem, especially when there's bowel that's trapped there.'cause then you can have a bowel injury which can lead to an infection and, and things like that.

Kerry:

But in general, hernia repair is pretty safe.

Jenna:

Especially, you know a first time hernia repair. Yes. They're usually very safe things that we think about, especially more so for inguinal hernia repairs in men are potentially problems having children in the future, or chronic groin or testicular pain. And the reason for that, again, is that. You know there the testicles go from the inside to the outside and there's tubes that are connecting them. And so those need to be protected throughout the procedure, whether that's done, open or robotically.

Kerry:

So I feel. Like meshes sometimes get a little controversy. Can you comment on that?

Jenna:

So the meshes that we use really 10, 15 years ago are no longer what I think most people are using. And they, a lot of those meshes got infected or they weren't. The right type of mesh. Now people are typically using a polypropylene or a polyester mesh where it's sort of woven and and almost loose, and that gives your body something to grow into. There are surgeons that are doing things without mesh, but I think the mesh we use all, for the most part, is a very, very safe, the very low risk of infection. I think what we were doing before, we, we had to learn that maybe that wasn't the best idea at the time, but no one was doing that on purpose. It was just a matter of, you know, this is what we had. We thought this was a great idea and it didn't work well. So when we talk about fixing umbilical hernias and people will say, well, we're gonna use a mesh, or, we're not gonna use a mesh and here's why, and would or would not. Yes. It's, it becomes very controversial. Most people would say that anything more than two centimeters needs a mesh now. Typically that's gonna be a mesh that doesn't go away. Sometimes. Let's say I did I took out somebody's gallbladder and they had a hernia and, and maybe one of the ports went through the hernia site.'cause that was just an easier way to access. And I wanna put a mesh in there. I might put a mesh that's gonna dissolve or say six months. And that might be a safer way to go. And for a lot of my young patients with small hernias that don't want a long-term mesh, I think that's a great option.

Kerry:

Do you see any like allergy type reactions to meshes?

Jenna:

That's pretty rare because you're using essentially nylon or polyester and so it's not like the, you know, nickel or cavan or things like that that patients tend to get allergies to. So not for the most part, but you know, anything's possible.

Kerry:

Mm-hmm. Okay. So we talked about, you know, the treatment and everything, but how do you prevent getting hernias?

Jenna:

So I think having a strong core in general is a great way to prevent hernias. But you have to be careful about the types of procedures that you do, or sorry, the types of exercises that you do. So when I see people doing situps and, and things like that, you can pull your rectus muscle apart and you really wanna work on the inner core muscles. And so I see patients, I probably see one patient a week who comes in with a diastasis, which is where the, you know, the rectus abdominal muscles wanna be kind of like this. Those are your six pack abs. And they end up kind of getting more like. This. And so this middle part here looks like a bulge, but there's no defect in the fascia. It's actually a diastasis. And in order to fix that, you need to strengthen the muscles behind your, your rectus abdom muscles to kind of pull those back together.

Kerry:

I was gonna bring up the diastasis recti, especially after pregnancy. This typically not something that you repair is what you're saying, right? You just

Jenna:

So typically it's not something that I would repair. I've certainly heard of people having a surgical repair of those muscles. I think that that's very challenging and I personally encourage my patients to do physical therapy and exercises before considering that because I, I think that I, I just think it's very challenging and very painful and I don't know you're gonna have the best results long term.

Kerry:

Mm-hmm. So you're, you're saying focus on the core. What, how does that work? I know the core goes down further, but like in the inguinal area, like is that still strengthening the core area or what is the.

Jenna:

You know, it's in because of inguinal Canal hernia inguinal canal anatomy. I think that's very challenging and there's not, in my opinion, a lot of exercises you can really do to strengthen that because they're, I. You know, there's a defect to sort of start with, but having a overall stronger abdominal muscles where, where they can sort of take that heavier load of day-to-day life is very helpful.

Kerry:

So that's what you know to do, but how about what not to do or.

Jenna:

So it's, it's really not lifting things appropriately, so you don't wanna increase your intraabdominal pressure. So things like holding your breath when you're lifting things, chronic constipation, lots of pushing. You wanna make sure that when you lift things or carry objects, you're doing them in a way where you're not gonna hurt yourself and not causing undue intraabdominal pressure. So breathing while you're moving or lifting things is super helpful.

Kerry:

The breath work when lifting is, is important. Right? Think

Jenna:

Yeah, absolutely.

Kerry:

And it's a similar thing for I was gonna say like incontinence for women. Right? You're gonna be lifting things appropriately because you can be weakening the pelvic floor muscles as well.

Jenna:

Yes.

Kerry:

Awesome. Well, is there anything that we missed on hernias?

Jenna:

No, I think that's, that's the majority of them.

Kerry:

Awesome. Well, this was so enlightening, and I know you briefly mentioned that like a hiatal hernia or internal hernia that's not, was on the discussion today, but that's, you know, a totally different thing that, and that you don't do. But if patients, you know, want to seek out to you for the other types of hernias, where can they find you?

Jenna:

So they can find me online at Florida surgical clinic.com and my office number is 7 2 7 surgery, which is 7 2 7 7 8 7 4 3 7 9. And I have offices in Bradenton and Sun City.

Kerry:

Awesome. Well, thank you so much for being on the podcast again. This was awesome. I keep learning more and more from you, so I appreciate it. I'm gonna have to like start giving CME for these. It's fantastic, but all right, everybody, have a good day and tune in next week. Thank you, Dr. Kazil

Jenna:

Thank. Thank you so much.

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