One of Canada’s foremost authorities on hernia surgery is nestled in a quiet part of the health-care cupboard – on the southwestern Ontario shelf right beside where they keep the orthopedic experts.
You guessed it, Chatham-Kent.
In September, Dr. John Morrison will take over as president of the Canadian Hernia Society. His intent is to continue to get the word out that too many people live in chronic pain, or have complications following hernia surgery.
With an estimated 80,000 people having such procedures in Canada each year, and about 20 million worldwide, the surgery is pretty common. All too common as well are complications from it, Morrison said.
Some hernias recur, and as many as 15% of people who have hernia surgery develop chronic pain as a complication, he said.
“Some hernias come back. We’ve managed with different repairs to reduce the number of recurrences, but in the process of reducing the number of people that get hernias again, the number of people that suffer from chronic pain after they have their hernia repaired has gone way up,” he said. “Some people – some young people – are left incapacitated. This is a serious problem.”
Morrison said the issues that develop are generally not due to the muscles healing poorly, but rather what is used to help the body heal.
“We think it’s because of the material we use to repair the hernia – it’s the mesh,” he said. “Some of these meshes, and the way they’re put in, we think are the cause of some of the problems that cause pain. Not all of it, but certainly since we’ve started to use these meshes, the number of people with pain has gone way up.”
In some cases, Morrison said, doctors have to operate and take the mesh out.
Morrison, who has more than three decades dealing with hernia patients, including about 25 years of repairing them laparoscopically, said hernias can occur for a variety of reasons, for instance developing as a result of the tissues not mending properly, whether it is from a surgical procedure or a naturally occurring phenomenon.
He stressed if someone suspects he or she has a hernia – and they are more prevalent in men than women – they should see a health-care professional.
“The best thing is to have a hernia fixed, unless there is another problem that makes it harder to fix – say they’ve got a bad heart,” he said, adding that in those cases, “unless it’s an emergency, you don’t fix it.”
There are different degrees of hernias. The big hernias occur in the people who’ve had previous operations. Morrison said up to 20% of people who develop such hernias suffer big time. “Sticking out like a football” is how he describes some he’s seen.
He said such large hernias generally occur from previous surgical procedures that just didn’t heal properly.
“And that usually occurs in about 20% of people,” Morrison said. “If they leave them when they develop after a surgery, they get bigger; they don’t get smaller.”
Ignoring a serious hernia can be life threatening.
“If you don’t get your hernia fixed, it can strangulate – the intestine can protrude through the abdominal wall to the point it starts to die,” he said. “It can happen in a small number of people. You’ve got a hernia there and the next thing you know, you’ve got a hell of a lot of pain and you’ve got to go into the hospital in the middle of the night to get it fixed.”
Morrison sees perhaps 200 hernia patients a year as part of his general surgery practice, some coming from as far away as Vancouver.
“But my thing now is basically hernias. The real tough ones. People that have had more than one. That’s what I do. That’s what I enjoy doing,” he said.
“If feel I’ve got the expertise to be able to help that person and I feel that the results they’re getting are as good as they’re going to get anywhere in the world. It gives me a bit of pleasure to see somebody fixed and back to doing the things they love –playing golf or out playing football – whatever they want to do – and they don’t get problems anymore. That gives me great satisfaction.”
Morrison began repairing hernias laparoscopically – using small incisions – in 1991 while working in Newfoundland. He came to Chatham three years later.
He said the procedure now is “purely several hours in the hospital for the most part,” Morrison said. “I send everybody home.”
That’s not the case everywhere. The Shouldice Centre for Hernia Repair in Toronto – a globally recognized hernia centre, keeps patients for up to three days.
“They have a whole program that they put people through,” he said.
Morrison said the prevalence of hernias has a real impact on our society.
“If you take into account the effect that hernias have on the economy, it is enormous. People don’t want to work. They’re off work for four or six weeks,” he said. “Think of 80,000 people off four to six weeks.”
Morrison said the average age of people suffering from a hernia is 50.
“A 50-year-old man, he’s in his prime at work, and he’s off for six weeks,”
He said he encourages people to go back to work as soon as they feel able, especially people with sedentary jobs. But they must work smart.
“If it hurts, don’t do it.”
For folks suffering with a hernia, or with complications following hernia surgery, Morrison said they should not feel isolated.
“It’s important that people realize they’re not alone in this. It’s not a serious disease. But it certainly can be a serious problem if you don’t get it looked after.”
Morrison’s expertise in the field has him recognized and respected around the globe. He said when he first began laparoscopic hernia repair, he taught the procedure to other doctors.
“When it was a brand new operation, I used to get invited to go here and there to show other surgeons how to do the operations.”
These days, he’s still spreading the word on proper hernia repair. Earlier this spring he presented at the 1st World Hernia Conference in Milan, Italy.
All that expertise operating out of Chatham-Kent. But Morrison realizes he’s not alone
“People here don’t realize the facilities they have here and the personnel they have here,” he said, pointing to the local orthopedic surgeons as being first rate. “The work the orthopedic boys do; they have patients coming from all over the place. We’re the place to do their hips and knees. That’s all they do and they are very good at it.”