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Spieglian Ventral Hernia — Very Concerned Post Op
Hello,
I was hoping someone here might be able to help alleviate some of my stress and concern.
I had a laparoscopic appendectomy on 6/19. The surgery and recovery was uneventful until 6/24 when I noticed a lump on my right side. The lump is located far to the side of the abdominal region, and sits higher than the belly button, it is appoximately 2-3 inches from a port incision from the appendectomy. It was originally about the size of a ping pong ball. After finding the lump, I made multiple trips to the surgeon and was told it was everything from a seroma to a lipoma. Finally, fed up I made a trip to the ER, a CT scan reveled a relatively small Ventral Spieglian Hernia. The hernia was all fat with no bowl protrusion. I was assured at the hospital that the hernia was no big deal and probably wouldn’t require surgery. The ER attending even went so far as to tell me that the hernia could strangulate and, since it was just fat, nothing would happen (I’m still not sure if that’s true).
I went back to the surgeons office the next day and after examining me the surgeon felt the hernia should be repaired. On 7/5 I underwent laparoscopic hernia repair. The surgeon said the hernia was small and he was able to repair it with stitches, he did not use mesh. Approximately one day after the surgery (when the swelling had gone down enough to notice), I found that the area where the hernia had been still had a protrusion about the size of a ping pong ball. I called the Doctor who suggested it was simply swelling and to give it time. After no improvement over the weekend, I had the CT Scan repeated. The radiologist who read the CT scan noted that there was still a ventral spiegilan hernia present. However, the surgeon disagreed with the radiologist and told me the hernia was repaired but that there was some fat left over that he could not push back in laparoscopically. He noted that he left the fat there because he wanted to avoid an open surgery and that the fat would eventually disintegrate. Concerned about the discrepancy between the radiologists opinion and my surgeon ,I sought a second opinion with a surgeon at another hospital. This surgeon suggested the same conclusion: the hernia had been repaired but there fat left over in the space and there was inflammation around the fat. I was told that it would dissipate in 4-6 weeks and that there was nothing to worry about. It has been 2 weeks and area is smaller, about the size of a marble. However, it still feels very deep seated and I seriously doubt that it is going to completely disappear. I’m not having much discomfort in the area but I am concerned about this lump.
I suppose most of my concern stems from being completely unable to find any reports of “left over fat” anywhere in my research. I am confused as to why this complication seems so unremarkable to my surgeon but is not really found in the literature. Further, I continue to have concern regarding whether the hernia was in fact repaired. Am I simply overreacting to a typical complication or should I be concerned?
I really appreciate anyone’s assistance.
Thanks,
Rob -
3 Replies
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Chaunce: It actually isn’t visual but only palpable, as was the original hernia. The area does seem to be shrinking (i.e. the generalized swelling has diminished) but the “root” of the lump feels very deep down and rooted. It’s sort of like having a small marble lodged in my side. I wouldn’t say it’s particularly painful. It’s interesting about the strangulated fat.
Thanks, guys. I agree, I am probably worrying too much. My concern stems more from this hospitals practice rather than the individual surgeon. The original surgeon who did my appendectomy and various residents on his team saw me three times with the ventral hernia and completely ignored me each and every time — I was first told it was a seroma, then that it was a harmless lipoma, and then that it was probably a seroma or a lipoma and not to worry about it. It got to the point where I was in a great deal of pain after eating and had to make a trip to the ER before anyone even considered the fact that it could be a hernia. Since the surgery I have not had any of the discomfort after eating so I am taking that as a very good sign. I check back in with the surgeon this week so I will try to update then. Again, THANK YOU for taking some time out of your day to lend some advice. I will sleep better tonight.
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Is it painful or causing any symptoms?
If it’s purely visual and also slowly shrinking, I would not be particularly concerned. Give it more time. Your surgeon is probably pretty skilled if they were able to fix a hernia without mesh through laparoscopy.
As for what the ER doc told you, I’ve also read similar suggestions that strangulated fat is often of no concern since it’s fat and isn’t going to do anything except plug the hole, though I think the exception to that is in the groin where inguinal/femoral hernias containing fat can be very painful.
Anyway, keep us updated on your progress.
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The bump is getting smaller, which supports what the two surgeons told you. If he sutured the opening close there will probably always be a small bump there from where he pulled the edges together, a small healing ridge, or internal scar. Plus the sutures themselves. I can still feel a very small bump where a needle was inserted to deflate my peritoneum during TEP surgery. The single suture used to close the hole left a bump, smaller than a BB, which will probably be there forever.
It’s barely been two weeks, barely enough time for normal swelling to reduce. I’d say that you might be getting ahead of yourself. Beside that there’s not much to be done. If there is a defect allowing fat to extrude, then when you get more active the bump will get bigger. Then you’ll know more. The radiologist can only see the results of the hernia, which would be the mass of fat. They probably can’t see the detail that the defect has been closed. I don’t think that fat has enough structure to be pulled without coming apart. That’s why the surgeon left it behind. Minimal disruption.
Good luck.
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