[DrOrenstein]

Postpartum Umbilical hernia?

Umbilical hernias during pregnancy and post-delivery is an interesting topic for general surgeons. During pregnancy your body releases hormones that help relax ligaments in your body as well as tissues of the abdominal wall. While this helps to physically stretch the abdominal wall tissue to make way for the growing baby, it can unintentionally stretch things like a small previously unknown umbilical hernia.

Many surgeons advocate waiting to fix umbilical hernias until well after deliver, and likely after completion of nursing, as this allows natural tightening of the abdominal wall & umbilical tissues. Many people won’t need their hernias fixed at all, though some still may require repair. There are several factors that surgeons take into consideration, including how symptomatic the patient is, the size of the hernia, body size, whether there are plans for future pregnancies, etc.

That said, if you are having significant symptoms from an umbilical hernia it should be checked out. This doesn’t mean that you definitely need a surgery soon, but it’s worth getting evaluated.

[DrOrenstein]

No mesh tissue repair surgeons in Washington or Oregon?

When it comes to inguinal hernia repair, tissue-based repairs are certainly becoming a lost art, as Dr. Towfigh already alluded to. Mesh-based tension-free repairs are the norm, at least in the United States. Much of this is due to surgical training in the U.S., with tension-free (Lichtenstein) repairs being taught almost universally, while tissue repairs are rarely taught. While tissue repairs can offer a solid repair, this is best undertaken at a high volume center or with a surgeon with more experience in these types of repairs.

Personally, I do not perform tissue-only repairs in the elective setting. This is due to the fact that I believe that mesh-based repairs are superior in the majority of patients, as well as my limited number of cases in which I perform tissue repairs (namely, only emergent cases where mesh is contraindicated). Additionally, traditional tissue-based repairs are repaired in an open fashion (one bigger incision). Minimally-invasive approaches such as with laparoscopic or robotic-assisted surgery (few small incisions) require mesh placement for reinforcement of the hernia, thus precluding tissue-only repair in the majority of patients.

With regards to the comment that it would be ok to have another repair in 15-20 years, I would argue that doing it right the first time with the most effective repair should be the norm. Re-operative surgery greatly increases risk of subsequent recurrence, chronic pain, and other potential challenges during the re-repair. While no procedure has a 0% recurrence rate, tension-free mesh repairs have been around for many years and have very good long-term outcomes.

Unfortunately, I do not know anyone in the Portland area that routinely performs tissue-based inguinal hernia repairs, but I will keep my ears open and will re-post if I hear something.

[DrOrenstein]

Exercising

I counsel my patients to resume they’re regular physical activity and exercise. The health benefits of exercise outweigh the potential for worsening a hernia. Listen to your body – if you’re doing a particular exercise and feel pain or other symptoms at the site of your hernia then perform it with a lighter weight, or eliminate that particular activity.

[DrOrenstein]

22 Year old Mesh, severe Inguinal pain, severe Periumbilical pain, both areas where mesh is implanted

I agree with everything Dr. Towfigh said and am happy to see you and evaluate you here at OHSU in Portland. If possible, obtaining any imaging you’ve had recently (the reports as well as the CDs of the actual images of CT scans, ultrasound, etc) would be helpful to bring to your appointment. Please call my office to set up an appointment at 503-494-4373.

Regards
Dr. O