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Umbilical Hernia: What is standard protocol?
Hi All
I had published a post some weeks back regarding a CT to evaluate for hernia.
The initial concern was an inguinal hernia, which is actually not the case. My discomfort in the inguinal area is likely due to adhesions from prior c-sections which, per the CT scan, are probably tethering my ovary to my inguinal ligament.That said, the CT also revealed a 3cm umbilical hernia “containing unobstructed colon.” (likely due to 2 pregnancies in 18 months).
The umbilical hernia doesn’t cause me much discomfort aside from what I’ve been assuming were occasionally “belly aches” around my belly button and some bloating.As I will likely be having a laproscopic procedure to evaluate the adhesions from my c-section and free up my ovary, I was wondering if it is standard protocol to have an umbilical hernia containing bowel fixed?
I lead a very active lifestyle and intend to resume my typical workout routines, which involve lifting and lots of interval training and running.
I don’t want to have to worry about this getting larger or causing issues with bowel strangulation. Is that something that you have to worry about with these types?next: I would intend to have both situations remedied at one time.
Would it be best to pursue a general surgeon vs. a gynecologist for this?
Are there physicians who specialize in both types of repair?Thanks again!
Brooke -
3 Replies
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[USER=”2955″]B_Rebovich12[/USER]
The umbilical hernia can be repaired at the same time that your ovarian adhesions are treated.
Talk with a surgeon that is experienced with umbilical hernia repairs (it could be your gynecologist).
A 3cm hernia can be repaired with either mesh or a pure tissue repair. Mesh has the advantage that it will decrease the recurrence rate, but can result in adhesions or chronic pain. A pure tissue repair has a higher recurrence rate but has less chance for pain.
Your surgeon needs to evaluate your anatomy, the strength of your tissues, and your personal needs.
Regards.
Bill Brown MD -
Coming from someone who had an umbilical hernia repaired, it’s not that bad, but this is just my experience and what I can tell you so far. I’m about eight months post-op, laparoscopic with mesh and absorbable fixation, and the only problems I’ve experienced were some tightness in my abdomen for the first two months. It was pretty rough tbh. All is well right now and I hope it’ll stay that way.
Keep in mind that most of the mesh complications are from inguinal hernia repairs, anatomically speaking, that’s a an area far from where the umbilicus is. You can barely compare the two types of repairs with mesh. It’s really rare to find mesh complications for a ventral hernia repair unless you have a mesh reaction or get an infection from it, which is possible. A lot of new techniques have been going around for ventral hernias and the latest one seems to be the TEP procedure and the other being a TAPP procedure. Those aren’t new for inguinal hernia repairs but they are for ventral repairs. They seem to have advantages compared to the traditional IPOM method, which the mesh is implanted against the peritoneum, but they are still pretty new techniques without very much evidence that they are superior than an IPOM repair. If you are going to go the mesh route, try to steer away from any kind of metal fixation. There is evidence that metal fixation does cause a lot of problems, so try to find someone who will be open to using absorbable fixation.
If you plan to get pregnant again, it’s best to go with the non-mesh route because once you are pregnant with mesh, you are pretty much bound to get a recurrence and that would involve removing the mesh most likely. If you don’t plan on that AND you really want to tackle the adhesions, then go the laparoscopic route, which will address both the hernia and your adhesions.
Remember, ventral hernias are different from inguinal hernias. Mesh complications differ between the two. I’m not saying that there are no complications at all with ventral mesh repairs, there are, but like I said, you can barely compare them to the ones experienced with an inguinal hernia repair. Most post-op pain for ventral hernias is due to the type of fixation which is its best to stay away from any kind of metal and permanent fixation, especially if you are thin.
In my opinion, it’s best to go with mesh since your hernia is 3 cm. That’s considered a medium sized hernia, according to most findings. Most experts, even the ones who remove mesh, suggest that hernias over 2 cm are best repaired with mesh. But please do find a surgeon who does hernias on the daily and is up to date with what’s going on in the field. Good luck to you!
Edit: Btw, I am active as well. I run and I bike quite often and like I said the only setbacks that I’ve had in my routine was when I was fresh in the recovery phase. But you will feel some tightness for some time in the area which will eventually go away.
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quote B_Rebovich12:I was wondering if it is standard protocol to have an umbilical hernia containing bowel fixed?
I lead a very active lifestyle and intend to resume my typical workout routines, which involve lifting and lots of interval training and running.
I don’t want to have to worry about this getting larger or causing issues with bowel strangulation. Is that something that you have to worry about with these types?next: I would intend to have both situations remedied at one time.
Would it be best to pursue a general surgeon vs. a gynecologist for this?
Are there physicians who specialize in both types of repair?Take your time and find a verified hernia specialist with a history of working on athletic people, with verifiable success. Make sure that they have a history of successful repairs, not just a web site that says they are a specialist. Whatever you do, do not just accept what the medical system provides at the first referral. There is a “lowest common denominator” approach to hernia repair, with a high risk of ruining your body for athletic activity. It involves maximum mesh coverage, designed to keep you alive and avoid future recurrences, but with little consideration for actual long-term physical, mental, and emotional quality of life.
As a strong healthy active person you will be tempted to think that you can “power through” whatever happens, just work harder until you’re healed, but with mesh problems the harder you try the worse things get. Read through old Topics on the forum, there are many from athletic people who can no longer do the things that they were assured they would be able to do. Nothing has changed over the last few years, the mesh revolution is still growing and being locked in by standardization of methods. Make sure that you get it right from the very beginning.
If you just take your primary physicians first referral, it is almost sure that you will get a mesh repair, possibly from a newly produced surgeon who only knows mesh implantation, with all of its known risks. Choose the physician you want and do whatever it takes to get them.
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