Leading Abdominal Hernia Surgery in Chicago

Wounds After Abdominal Surgery

The first step in an abdominal wall reconstruction is for the surgeon to attempt to heal any open wounds that remain after the last abdominal surgery. Often, local wound care with dressings is all that is needed to get wound closure.

Some small and deep wounds are due to retained stitches that had been used to suture the abdominal wall muscles. Getting rid of the sutures often allows the wound to close by themselves. This is often done in the office, and sometimes in the operating room. The risk to this procedure is creating a hole in the intestines while looking for the suture. To decrease the chance of this happening, Dr. Dumanian will often get a CT scan to see if the bowel is near the open wound.

Some patients with large open wounds require skin grafts to achieve a healed wound. The skin grafts are taken from the leg, and placed on the surface of the open wound. The procedure typically is successful. Dressings and protection of the newly skin grafted area is needed for a few weeks after surgery.

Large wounds that develop after abdominal surgery often mean that a hernia will develop for that patient. When the open wounds are treated and the skin is healed, the internal scar tissue softens, and a weakness of the abdominal wall becomes obvious. The hernia that results becomes bigger with time. The time to fix the hernia is when the hernia is becoming larger, because that means that the internal scar tissue has mostly gone away.

Medium and Massive Hernias

Massive hernias are repaired using the same techniques as used for smaller hernias. People with massive hernias more often require the use of either permanent or biologic mesh to help close the abdominal wall. The surgeries take longer, and require longer hospital admissions. The hernia recurrence rate may even be a little higher. Dr. Dumanian will need a CT scan for planning the procedure, to make sure there are no other hernias or bowel problems that would need to be addressed.

One problem with fixing the most massive hernias is with the lungs. Putting the intestines back within the abdominal wall may put pressure on the diaphrams and the lungs, making breathing difficult after surgery. Patients with long smoking histories, emphysema, or a previous tracheostomy may have the greatest problems after surgery. Your doctor may conclude that the hernia is too risky for your lungs to repair.

Some patients with massive hernias have associated problems with the intestines. These patients may need bowel removed at the time of the abdominal wall reconstruction. If this is necessary, Dr. Dumanian would work with a general surgeon to perform the reconstruction.

Umbilical Hernias

A weak area of the abdominal wall occurs at the umbilicus, or belly button. The area is weak, because of the way that babies are formed in the uterus and the umbilical cord. Umbilical hernias do not tend to become overly large, but they can be bothersome and painful. There is also a small risk that a loop of intestine becomes caught outside the abdominal wall and the bowel loop can strangulate and die. This is a rare but potentially very serious condition.

There are two very different ways to repair umbilical hernias. One method makes an incision around the belly button, and uses stitches or even a piece of mesh to reinforce the weak area. A completely different method of repair involves an incision near the pubic hair, lifting the skin, and repairing the stomach muscles back together from the breast bone (the lower aspect of the sternum) to the pubic bone. The umbilical hernia is therefore repaired essentially over a much longer area, rather than stitches just at the hernia site. This repair involves both the hernia repair, and the same techniques used for an abdominoplasty, or tummy tuck. Part of the procedure is paid for by your insurance plan, but there are extra charges to the patient for the surgeon’s fee and for the operating room for the cosmetic aspects of the procedure.

Hernias Associated with Ostomies / Parastomal Hernia

Some of the most difficult hernias to repair are the hernias associated with ostomies, or exit sites of the bowel. This could include colostomies, ileostomies, or ileal conduits for patients who have had their bladders removed. In general, Dr. Dumanian attempts to repair the site where the colostomy exits the abdominal wall. This involves decreasing the abdominal pressure with the separation of parts procedure, weakening the abdomen a bit to there is not as much pressure on the bowel at the stoma exit site. It also involves the re-repair of the stoma exit site, usually with a piece of mesh. Of course, use of mesh has its own potential complications including possible infection and need for removal. Dr. Dumanian will need a CT scan for planning the procedure, to make sure there are no other hernias or bowel problems that would need to be addressed.

In certain instances, the stoma will need to be moved from one side of the abdomen to the other. If this is the case in your situation, you would be referred back to your original surgeon, or else a similarly trained surgeon at Northwestern Memorial Hospital.

Hernias After Massive Weight Loss Surgery

Patients who have had bariatric surgery often develop hernias. These hernias are repaired with the same techniques outline above. This includes using mesh, and the separation of parts procedure. Excess skin that occurs after weight loss surgery is often removed during the same hernia operation. However, this is a cosmetic procedure, and would not be covered by your insurance. Speak with Dr. Dumanian at the time of your meeting if you would be interested to remove extra skin at the time of your hernia procedure.

Cosmetic Abdominal Surgery

Dr. Dumanian is an expert at all types of cosmetic surgery of the abdomen and the trunk, and performs them frequently. This includes liposuction of the abdomen and flanks and full tummy tucks (full abdominoplasty). Speak with Dr. Dumanian if you are a good candidate for one of these procedures, and what would be the risks and benefits in your specific situation.

Mesh

The decision whether to use mesh or not is complicated, and you will need to discuss this with Dr. Dumanian. Using a permanent mesh decreases the recurrence rate of a new hernia developing. However, meshes also can become infected, cause adhesions to the bowel and bowel blockages, or cause holes in the bowel to develop. In general, Dr. Dumanian feels that the benefits of using mesh and the associated decreased hernia recurrence rates outweigh the risks in many situations. Mesh is used typically at the same time as the separation of parts procedure.

Dr. Dumanian is an authority in the use of meshes for reinforcement of the abdominal wall. He has published his results on hundreds of repairs using his “three-line technique”, as well as his procedure for sparing blood vessels to the skin for “components release” repairs. Dr. Dumanian on occasion will use a biologic mesh to reinforce an abdominal wall closure. When these materials are used in a Chicago abdominal hernia repair they seem to avoid some of the other problems seen with permanent meshes, namely infections and adhesions. However, they also are associated with higher hernia recurrence rates. Speak with Dr. Dumanian if he plans to use either permanent or biologic mesh.

Mesh Infections

From a previous hernia repair, you may already have a draining area and a mesh infection. This is a serious situation, and typically requires the complete removal of the mesh. Depending on the type of mesh that was used for you, Dr. Dumanian may need to perform a complete abdominal wall reconstruction after the mesh is removed. In other instances, the mesh is removed at one operation, a hernia slowly redevelops over time, and the hernia is then repaired when there is no infection present. Dr. Dumanian has extensive experience in treating patient with infected abdominal wall mesh.