One of the most effective treatments for hernias could be patient education
Surgical repair of hernias in people is one of the oldest known surgical procedures with written accounts going back almost four thousand years. It’s also one of the most commonly performed surgeries. However, it’s only recently that some of the most dramatic advances have been developed.
Two champions of educating patients about their potential surgical options, post-surgical recovery and of compassionate pain management are Luke Elms, MD, and Bobby Gibbons II, MD, both Board Certified surgeons with Orlando Health Medical Group Surgery, based at Orlando Health Dr. P. Phillips Hospital.
“Following a protocol, such as ERAS (Enhanced Recovery After Surgery), and educating patients beyond the standard level of counseling to effectively manage their expectations for the recovery process are two elements we’ve seen significantly improve outcomes,” Elms said.
Under ERAS patients’ pre- and post-operative diets are developed (fasting is avoided) and getting the patient out of bed and moving around soon after surgery is emphasized. And, in order to regain mobility sooner, using a more tailored approach to pain management can shorten a patient’s recovery time – but this approach requires the patient have a better understanding of the realities of recovery than they often have under older protocols.
“Not all pain is equal,” said Elms. “We believe a multi-modal approach is best with specific types of pain medicine for specific types of pain.”
The doctors note that approximately 20 million Americans are currently dependent on opioids and another 20 million self-report as recovering from opioid dependency. Another troubling statistic indicates that 7 to 9 percent of post-operative patients are taking opioids 120 days after their surgery.
“Opioids are still an important part of compassionate pain management,” said Elms. “But if we can reduce their use appropriately there are beautiful benefits for the patient such as reduction in constipation and nausea, which are linked to post-operative issues.”
Cutting down on opioid-related side effects also cuts down on post-operative calls to the surgeon added Gibbons.
To win buy-in from the patient, doctors need to have focused conversations with their patients to help them understand the benefits of this approach. “Combine a defined protocol, such as ERAS, with purposeful patient education,” said Elms.
Educating the patient earlier equals leaving the hospital sooner for many patients according to Gibbons.
Before patients can get to a speedier recovery, it also helps if they have recognized the need for treatment early. If physicians have the opportunity to address a surgical need sooner, it provides more options for less invasive techniques such as robotics.
“Sometimes traditional laparoscopic tools can seem a little like using one of those mechanical grabbing tools that groundskeepers use to pick up trash,” said Gibbons. “Robotic tools move more like a human wrist than traditional laparoscopic tools and they can do so much more now.”
Robotics are both the present and the future. And where robotics is revolutionary now is in how it allows more surgeons to use the tools with great precision, even if they haven’t been fellowship-trained in certain techniques. And this enhances recovery times.
The bottom line for patients is to anticipate that there is going to be some pain and discomfort following surgery, but that a multi-modal approach to pain management is one of the best ways to speed the recovery.
“Minimally invasive surgery doesn’t mean pain-free,” Elms said. “But a carefully managed approach can mean a much shorter recovery time.”
Elms is a board-certified general surgeon who joined Orlando Health Medical Group in 2015. He grew up in Oklahoma and earned a bachelor’s degree in biology from Oklahoma City University before earning his medical degree from the University of Oklahoma College of Medicine where, he was awarded The Oklahoma City Surgical Society Award. He completed his general surgery residency at Orlando Health, where he served as the administrative chief resident during his final year and was awarded the Academic Achievement Award.
Elms has participated in numerous research projects and presentations during college and residency. He co-authored a paper entitled: “Causes of Small Bowel Obstruction After Roux-en-Y Gastric Bypass: A Review of 2,395 Cases at a Single Institution that was published in the journal, Surgical Endoscopy.
In addition to being board certified in general surgery, Dr. Elms also has certification in robotic surgery. He is a member of the American College of Surgeons, ACS Florida Chapter, and Florida Medical Association. He has particular interest in minimally invasive surgery and robotic surgery. He serves as teaching faculty to the general surgery residency program at Orlando Health.
Gibbons joined Orlando Health Medical Group Surgery in 2016. Gibbons certified in basic life support, advanced cardiovascular life support, fundamental critical care support and serves as an instructor for advanced trauma life support and Advanced Surgical Skills for Exposure in Trauma courses.
After completing a bachelor’s degree in Biomedical Engineering from Vanderbilt University, Gibbons worked in research and design of medical simulation technologies and curricula. Following this, he earned his medical degree from the University of Louisville School of Medicine. He went on to complete his general surgery residency at Orlando Health.
Prior to joining Orlando Health Medical Group Surgery, Gibbons presented research at multiple national meetings, and co-authored an article titled “Presumptive Antibiotics for Chest Tube Insertion? available online at surgicalcriticalcare.net
Gibbons is a member of the American Medical Association and the American College of Surgeons. He has a particular interest in minimally invasive and robotic surgery as well as surgical education.