A Gut-Wrenching Feeling

Tension-free repairs for painful inguinal hernia include laparoscopic surgery


For 39 years, David Napoli, DC, has been providing chiropractic care at his Broward County practice, where he specializes in treating

sports injuries, personal injuries and injuries suffered by workers on the job.

It was his personal experience with chiropractic that influenced Dr. Napoli’s decision to pursue a career in the field.

“In high school, I injured my back playing football,” the Pittsburgh-area native relates. “I was told I needed surgery on one of my discs, but I ended up seeing a local chiropractor instead. Within four or five months of treatment and rehab, I was playing ball again.”

“After high school, I attended Palmer College of Chiropractic in Davenport, Iowa, and earned my doctorate in 1982. That’s the original chiropractic college in this country. It’s considered the Harvard of chiropractic educational institutions. It was founded in 1897 by Daniel David Palmer, and I had the pleasure of graduating from there.”

Dr. Napoli, 63, also enjoyed the pleasure of never needing any type of surgery — until a couple of years ago, when he was injured during an automobile accident.

“My car was hit, went off the road and landed on its side,” Dr. Napoli recalls. “I tried to open the driver’s side door to get out, but the doors are very heavy when the car is on its side. I strained to get the door open, and I felt a pop in my left groin. Then I felt pain on my left side.

“The pain wasn’t excruciating, but after a while it started to really bother me when I was on my feet for extended periods of time. Gradually, it got worse to where I was experiencing a throbbing, aching pain at night. When it got bad, it was an eight or nine on a scale of one to 10.”

Dr. Napoli soon learned that the cause of his pain was a hernia triggered by his attempt to open the car door. A hernia occurs when an internal organ or other body part protrudes through the wall of muscle or tissue that normally holds it in place.

Seeking a remedy, Dr. Napoli began interviewing local physicians about the surgical interventions available. He came away quite discouraged.

“I know many doctors on the state’s east coast because I practice there, but I wasn’t very impressed with any of the doctors I visited,” he laments. “So, I went on the internet and Googled doctors who did hernia surgery and the techniques they use. I picked three physicians on the west coast to interview. One was Dr. Napoliello.”

David A. Napoliello, MD, is certified by the American Board of Surgery and is a fellow of the American College of Surgeons. He has offices in Bradenton and Venice.

“When I first called Dr. Napoliello’s office, I talked to his staff and left a message,” Dr. Napoli explains. “Unbelievably, Dr. Napoliello called me back and spent an hour and 15 minutes on the phone explaining the procedures he offers. I was very impressed.”

Bulging Tire

Dr. Napoliello explained that hernias can develop in adults and children as a result of heavy lifting, straining, coughing or any unusual stress that causes a sudden increase of intra-abdominal pressure.

Some hernias are congenital, meaning they are present at birth, whereas others develop as a result of a predisposition for hernia. Also, anyone who has had surgery may experience a weakening of tissue at the incision site that could result in a hernia.

“Dr. Napoli had an inguinal hernia, which is the most common,” Dr. Napoliello reports. “Inguinal hernias occur due to a defect or weakness in the abdominal muscle wall through which intestine and fat layers protrude and form a visible bulge in the groin area.

“To visualize the dynamics of it, think of an automobile tire. The abdominal wall is like the thick outer wall of the tire. Should the tire get damaged, the inner tube can push through the weakened area or crack, forming a small bubble.

“If the abdominal wall becomes weakened, the tissue that lines the inside of the abdomen and holds the intestines in place, called the peritoneum, can bulge into the outer wall. In the tire, the inner tube can become strangled by the pressure of the edges of the crack through which it protrudes. It’s the same with a hernia.”

The first sign of a hernia is a bulging under the skin. Additional symptoms may include discomfort while lifting heavy objects, sneezing or coughing, straining while using the toilet, or pain while standing or sitting.

Because delayed treatment can sometimes lead to the intestine being trapped inside the hernia sac, resulting in gangrene, any bulge should be brought to a physician’s attention immediately so that diagnosis and treatment can begin. If left untreated, certain complications from hernias can be fatal.

Repair Techniques

To repair hernias, surgeons have the option of several techniques. Surgeons typically choose the best option depending upon the patient and the size of the hernia.

“Formerly, the only hernia repair option available was an open surgical procedure called a tension repair,” Dr. Napoliello observes. “The physician makes an incision, pushes the protruding tissue back into place and stitches the tissue layers together. The potential disadvantages of this type of surgery include relatively long recovery periods, high recurrence rates and discomfort following surgery.

“Today, we can offer a variety of minimally invasive open procedures, as well as laparoscopic and robotic procedures. Unlike a tension repair, these are tension- free because the stitches or sutures that are used do not put tension on the sides of the defect to keep it closed.

“Instead, we use special mesh patches that limit the size of the required incision. These procedures offer lower recurrence rates, quick recovery and only minor discomfort. The minimally invasive open approach can also allow the patient to avoid being placed under general anesthesia.”

There are two main options for robotic and laparoscopic surgery, the skilled surgeon continues. “In the transabdominal approach, the physician makes a small incision and slides a laparoscope, which is a thin telescope, through the abdominal wall. For the preperitoneal approach, the laparoscope slides between the tissues of the abdominal wall, never entering the abdominal cavity. With both approaches, surgeons view the hernia and surrounding tissue on a video screen.

“I Feel Fantastic”

Dr. Napoliello repaired Dr. Napoli’s inguinal hernia using the preperitoneal laparoscopic approach in February 2021.

“He made three small incisions and performed the surgery through those,” Dr. Napoli describes. “He inserted air around the hernia and worked within that space. He did a great job. It took care of my problem, and I healed up nicely.

“I have a clean bill of health. The pain is gone, and I feel fantastic. I’m playing golf again, swimming and even doing some light weightlifting. I couldn’t do those activities before the procedure; the pain was too great.

“My hernia surgery was one of the smoothest procedures I ever went through as far as my health is concerned.”

The chiropractor says the surgeon is a fantastic medical colleague.

“He’s very cordial and professional and knew exactly what needed to be done,” Dr. Napoli raves. “He’s also very efficient and did everything correctly.

“I drove three hours from Fort Lauderdale to Sarasota to have my hernia procedure done. That’s how confident I was in Dr. Napoliello. And it was a great experience.” 

Florida Health Care News

Print This Article