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Hernia Surgeon
Hi Dr Towfigh,
I have bilateral inguinal hernias and a tiny umbilical hernia, would you know of a hernia specialist surgeon you would recommend in Connecticut?
I live close to Hartford so either the Hartford area or Yale New Haven would probably be best but if you know of a skilled hernia surgeon further away and think it’s worth it that would be fine.
Also, I just wanted to see if you have ever heard if this unusual issue related to the Urachus remnant:
I have already spoken to 2 surgeons and received 2 very different opinions. One would do TEP and suggests just do one side for now (that contains bulge and is symptomatic, says that to do other two at the same time may result in too much pain). The other would do TAPP and do all 3 at once. My question for you is the latter surgeon said He would not go in below the belly button for a port – he says my description of pain when belly button is even slightly touched inside (pain is deep inside – down to groin area, have had this always and remember it even as a very young child) indicates it may be related to the urachal remnant and therefore making the port below the belly button may touch this and cause other problems. So he would go in above the belly button and use TAPP.
The other surgeon who would do TEP and would go through a port below the navel, said he has never heard of this before. Said it’s not even scientific.
Have you ever run into this or heard about this? I do see that the urachus is sometimes removed in infants or children for abnormalities and that he incision is made bellow the navel, but I don’t see anything related to laparoscopic surgery for hernias mentioning this. Maybe it’s because it’s such a rare condition?
There is a possibility he was referring to something other than the Urachal remnant (the only notes my wife and I have on this is state he used the word ‘canalize’) but it’s the only thing I see that seems to fit what he described (“normally obliterated before birth†etc.). I have a follow up appointment for questions in a couple days and will confirm this.
Thank you for the helpful information on your website.
Thank you very much
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4 Replies
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Hernia Surgeon
Dr Goldstein would be a great choice for you!
In some, the urachusbis patent (open) and is basically a communication from your bladder up to your belly button as a small tube down the middle. A CT scan with contrast or ultrasound can tell you if you have a patent urachus. It’s not common and your symptoms are likely due to your hernia.
In TEP, the fascial entry is actually to the side, so it’s a non-issue with the urachus. I agree with Dr Earle that I would not change the port placements based on this supposed problem. If a patent urachus is noted, it can be addressed and should be stapled off very low at the bladder level and sent to pathology for examination.
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Hernia Surgeon
Thank you both for your replies and yes the information is very helpful. Your comment that everyone still has the umbilical remnant led me to look into this further and I found the following statement which, if I’m understanding correctly, is saying that it’s not the urachus that is obliterated, it is the connections (“communicationsâ€) that are usually obliterated:
Umbilical anomalies.
Griffith GL, Mulcahy JJ, McRoberts JW.
AbstractDuring intrauterine development the primordia of the developing gastrointestinal and urinary tract come into close proximity in the umbilicus where the communication of these structures with the external environment is usually obliterated. In a small percentage of patients the omphalomesenteric duct and/or urachus may remain completely or partially patent. When complete patency is present, drainage of mucus, stool, or urine may occur. Partial patency may be manifest by an abdominal mass or by no symptoms at all. Definitive treatment includes total excision of the omphalomesenteric duct and/or urachus, lest recanalization of remnant tissue or carcinoma in later life occur.
http://www.ncbi.nlm.nih.gov/pubmed/472824
It’s interesting this quote also mentions “recanalization†because I believe he used that term or something similar to describe what may exist.
So perhaps he is just being cautious in suggesting avoiding that area, I’m not sure, but will ask about this on Friday. Or perhaps since I mentioned my reluctance to have this done laparoscopically after having heard it’s often done thru the belly button (for me a horrible thought!)
One other question/concern, if the port for the camera is going to be above the navel, and the umbilical hernia is being fixed with open, do you think having 2 holes so close together could be a potential issue? Since the umbilical is considered very small (the CT scan report says “tinyâ€) maybe I should just not have it done at all (it doesn’t bother me at all).
Dr Goldstein, I did check and yes you are about 2 hours from me so that may be a possibility. I’ll see how this next appointment works out first. This surgeon has done about 2500 of these so thankfully he is past the 250 – 500 Dr Towfigh mentioned is needed in another post (due to the steep learning curve of lap hernia surgery). But since there is always that small risk of chronic pain I do want to make sure I select a very skilled surgeon.
Thanks again for your help.
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Hernia Surgeon
CT Hernia – 1. Everyone has a urachal remnant. Whether or not it is the cause of your symptoms is difficult, if not impossible to know. 2. If you have bilateral inguinal hernias, and a laparoscopic approach is planned, it would usually be inappropriate to not repair both sides. 3. Either TEP or TAPP is appropriate, no need to alter port site location. 4. Repairing the umbilical hernia at the same time with or without mesh is also appropriate. With limited info, my approach to this would probably be bilateral TEP with umbilical hernia repair through the umbilical incision (with or without mesh). Hope this helps!
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Hernia Surgeon
I am a hernia surgeon just outside of Albany NY. I do TEP routinely and often combine that with a mesh umbilical repair. It should be no problem to excise a urachal remnant at the same time. If you want to travel a couple of hours, I’d be glad to take a look. My website is http://www.littlescars.com
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