Lump above incision site, worried it could be a recurrence.

[Good intentions]

Hello @Wez27

It might help to get more fine details about the previous surgery. The range of possible materials and methods is very wide, and you might find that there are better options elsewhere. It’s been discussed on the forum that many surgeons don’t actually have a choice when it comes to the mesh that they use.

I can’t get a clear image of what you’re describing. You said that lap was used to repair an umbilical hernia, but that now you have a recurrence above the incision site. A recurrence would be the umbilical hernia returning. A hernia above the incision site would be a new hernia, an incisional hernia.

I would not assume that you have weak tissue and are prone to hernias. I don’t think that that is the primary reason for umbilical hernias, and incisional hernias are not uncommon.

The words “bigger mesh” imply that a piece of mesh already exists at the incision site. That would mean mesh at the umbilical site and at the incision site. It might be worthwhile to get a full picture of what exactly has been done in your past surgeries before moving forward. You don’t want to get on to the treadmill of mesh after mesh after mesh. Since you’re having unexpected results it is completely reasonable to get a second opinion. Your surgeon should not be offended and might even welcome it.

[Wez27]

Thank you for the reply and your attention to detail. You are right to be a little confused. I am still processing everything after today.

To clarify. I had an umbilical hernia repaired a year and a half ago. This was done laparoscopically with dynamesh, I believe. Shortly after, I started experiencing intense abdominal pains, which turned out to be gallstones. 4.5 months ago I had a cholecystectomy (same surgeons), who opened up the same incision that was used for the hernia operation.

2 weeks ago I noticed a bulge slightly above this incision, which I was hoping was a seroma. But today the surgeon confirmed – via a physical exam – it was a hernia (he could feel the hole in my abdominal wall). This is a little above where the original hernia occurred, so I am assuming you are correct in judging it to be an incisional hernia. I am not sure whether the mesh has failed, or whether the new hernia has occurred just outside it. He suggested open surgery with a bigger mesh to cover the area, although I was a little disoriented from the unfortunate news.

May I ask? Do you suggest in my case that this would not be an optimal solution? Since I am in Europe and not in my home country, things are a little difficult for me to negotiate and I am unsure where to turn except the surgeons that operated on me previously.

• This reply was modified 1 month ago by  Wez27.

[Good intentions]

I am only suggesting that you take extra time and care before deciding to go ahead with another surgery, with the same surgeons. Your gall bladder removal should have been a simple laparoscopic procedure. From what you wrote it seems that it is the cause of your problems today. Maybe the surgeons are not as skilled as others might be. It is well-established that surgeons need a large number of “practice” laparoscopic surgeries before they become proficient. Maybe you are one of those “training” cases. It is a subject that is not well-discussed. Was your gall bladder removal done via open or laparoscopic methods? You didn’t actually say. It can be done both ways.

Your surgeons might be considering extreme measures to avoid the shame of another failed surgery. In other words, they might be suggesting something that is more for their benefit (avoiding a recurrence) than yours. One obvious question is “why do they suggest open surgery when normal laparoscopic procedures should work?” I had two TAPP procedures to remove mesh within 5 weeks, and have had no problems in the seven years since. An open abdominal surgery actually increases the risk of incisional hernia. Reducing that risk is one of the real benefits of laparoscopy. What they are suggesting increases your risk of future hernia. I linked to a recent paper about it below. A 15-20 percent chance of incisional hernia after laparotomy (open surgery).

In short, they have failed once so seeking the advice of other experts makes sense. They will certainly keep trying to help you but they might not have the ability.

As I went through my own hernia and mesh problems I was surprised at how many different opinions there were about the best path forward. People at high levels in their own organizations were more concerned with their own welfare than mine. It’s just human nature.

Be careful. It’s very tempting to just give in and trust the surgeons. But there are good ones and bad ones. You have to find the good ones and avoid the bad ones

“Despite advancements in techniques for abdominal wall closure the incisional hernia rate following laparotomy is as high 15% to 20%.”

https://www.ncbi.nlm.nih.gov/books/NBK435995/

https://my.clevelandclinic.org/health/procedures/21614-gallbladder-removal

[drtowfigh]

Definitely have your surgeon re-examine you. You may need imaging to confirm whether this is a persistent fluid collection or a hernia recurrence. I recommend CT scan with valsalva and oral contrast.

For those who need surgery after an abdominal wall hernia repair, it is important to let your surgeon know that you have had a hernia repair and/or use of mesh. Ideally, your surgeon should try their best not to go through the repair and instead use alternate routes for your operation.

[Wez27]

Thank you for replying. I saw my surgeon today who did a physical examination. Unfortunately, he confirmed it was a recurrent hernia, somewhat above the original site. He recommended open mesh surgery, using a larger mesh.

I am feeling very low right now, as I took a lot of care to not overdo it physically since my first repair. Obviously I have a genetic defect which makes me more susceptible to hernias. My worry now is how to prevent a further recurrence in the future since the chances of recurrence are higher each time (and as I said, I wasn’t straining myself beyond normal daily activities). I am male, 42, healthy BMI, non-smoker, no other health issues.

I won’t have the surgery immediately since the hernia is symptomless and I can’t take time off work. I plan to do it in May/June next year. I am worn out with surgery since this will be my fourth in 3 years.