Hernias?!?

   I am just asking a general question about one of the possible things that can occur from having WLS.     I have recently decided to have WLS and am in the beginning phases of my journey and know it's a VERY long journey.   I am trying to embrace the journey, as a whole, and learn as much as I possibly can.  So far, everyone is AMAZING and I love the unity that is promoted at OH.  In reading various posts and pages, I notice MANY people seem to have had hernias.  It is almost even referred to as part of the surgery process:  "met with surgen, did X test and Y test, had surgery, had hernia repair surgery, etc etc".  I am just curious how many people can shed light on this and how many people here have experienced them.     Again, I know sometimes these things are rare..although they can happen. I am preparing myself for everything (just in case) but hoping for the best.  I am not changing my mind at all.  Afterall, I know the surgery in my heart is what I need/want.  I know it is my last resort at leading a healthy life hopefully for the rest of my life.  I am just a worry-wart that can be very fearful at times.  Is this all normal? Thank you in advance to everyone!! :)

David, The Worry?- Pre-Op jitters? As common out here as Deep navels. Hernias? Unfortunately can be pretty common as well, especially for Men. According to a poll taken of Bariatric Surgeons last year, Men are more likely than women to develop hernias after Bariatric surgery than women. The most common type is the incisional hernia- followed by inguinal hernia. Most of it is due to the fact that Men carry more of their excess weight on their torso and abdominal region, thus the internal pressure is greater. I had a femoral hernia (the type that some women get after a pregnancy) and it was repaired laproscopically as an out-patient surgery. Fast as a drive through order at McDonalds. Literally I was in and out and at home on the mend in less than 4 hours! Internal hernias, "Peterson’s Hernia" or strangulated intestines are more much more rare, but do happen. About 3 or 4 of the guys here have had such, and hopefully they’ll see your post…. Now, back to the "worry-wart" thoughts… WLS is very serious undertaking, but one that has a statistical advantage--- Namely, a 10% increase in lifespan--- SOME OUTCOMES OF BARIATRIC SURGERY (information taken from Clevland Clinic Journal of Medicine, March 2006) Dr. Buchwald (*) collected data on outcomes of bariatric surgery In a meta-analysis of 22,094 patients. The average excess weight loss for all types of procedures was 61.2%. When stratified by type of surgery, the average excess weight loss was: • 47.5% for gastric banding • 61.6% for gastric bypass • 68.2% for gastroplasty • 70.1% for biliopancreatic diversion/duodenal switch. Overall, each type of surgery was safe, with the more complex surgeries Carrying a greater risk of morbidity and mortality. Mortality ranged from a low of- 0.1% for restrictive procedures To 1.1% for biliopancreatic diversion/duodenal switch. The Effect on Comorbidities? Importantly, the reductions in comorbidities are also quite impressive. In this same meta-analysis, Diabetes resolved in 76.8% of cases, Lipid profiles improved in 70.0%, Hypertension resolved in 61.7%, And obstructive sleep apnea resolved in 85.7%.(*) Effect on life span? Evidence suggests that bariatric surgery also increases life span. In a study comparing survival between 62,781 morbidly obese patients Who had undergone gastric bypass And 3,328 morbidly obese patients who had not, The 15-year survival rate for patients younger than 40 years was 13.8% For those who underwent surgery vs 3.0% for those who did not.(**) (A 10% increase of Life Span) Effect on overall health costs? Studies are beginning to emerge that suggest that bariatric surgery Yields savings in overall health care expenditures over time. Typical are the results of a retrospective study by Potteiger (***) In 51 consecutive patients with obesity-related hypertension and diabetes Who underwent bariatric surgery. The average number of medications Taken by these patients fell to from 2.44 preoperatively to 0.56 At 9 months after surgery, and the total monthly cost of their diabetic And Anti-hypertensive medications declined 77% over the same period. Obesity is a major public health problem in developed nations worldwide. Currently, the only treatment for severe obesity (BMI ≥35 kg/m2 with comorbidity) That provides long-term weight loss is bariatric surgery. Restrictive, malabsorptive, and combination procedures have been developed. Each type of procedure has its merits and unique set of risks and complications. Weight loss after bariatric surgery is accompanied by predictable improvement Or resolution of obesity-related comorbidities and improved quality of life And life expectancy. Candidates for bariatric surgery are often at high risk for complications Because of obesity-related comorbidities. Therefore, careful patient selection for bariatric surgery, Together with well-designed strategies for preventing and managing complications, Are keys to success. Close monitoring for nutritional deficiencies And short- and long-term complications is required To completely assess outcomes of these procedures.

From the following studies------- *. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292:1724–1737. **. Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg 2004; 199:543–551. ***. Potteiger CE, Paragi PR, Inverso NA, et al. Bariatric surgery: shedding the monetary weight of prescription costs in the managed care arena. Obes Surg 2004; 14:725–1730. Hope this helps with the worries, and others just scanning by as well! Best Wishes- Dx

I have an incisonal hernia.  It itches on occation but otherwise is no issue.  Well, it also sticks out like a bubble when I contract my abdominals but that is nothing.  Hopefully, it will help with insurance when it is time to get my extra stomach removed.  That is my lame hernia story. Scott

If you get thin, you may get a Peterson's hernia or other internal hernia. The fat loss causes pulling on the staples or other surgical work that the surgeon does. It's impossible for the surgeon to predict in what way that is going to happen or to know how to avoid it.

I had an internal hernia about 12 months out. This is from my profile:

"Complications - Internal hernia - pretty common among lean male post-ops

In my 12th post-op month, after an intentional 10 lb. loss intended to serve as a "buffer zone" against future regain, I developed occasional severe pain which seemed to be caused by trapped gas. A CT revealed an abnormal amount of gas and my surgeon suspects an internal hernia (narrow spot(s) in the small intestine). He recommends surgery to check it out and also repair any potential or existing hernia-causing defects, to avoid emergency OPEN surgery in the future.

The doc says that there is no way to diagnose such a hernia without looking inside, in this case, laproscopically - the preferred way.

I got some temporary relief by taking probiotics, sipping on carbonated beveridges and taking Glutamine upon arising. Maalox Multi Symptom also seems to help at times.

Had lap surgery again to get rid of hernias and defects. Doc found and repaired a Peterson's Hernia (Defect) and several potential defects in the Omentum, where the fat therein had shrunk and was pulling on the staples and getting ready to shred.

Read about Internal Hernias and other complications here:

http://www.bcm.edu/gastro/DDC/grandrounds/BCM/2-23-06/09-DIS C.HTM

A few days after surgery, I finally got a lot of energy. Wonder if the lack of flow had been causing an immune response or poor digestion, which was causing me to be tired?"

Dave

Dave, I had my lap RNY on 2-23-07 and have lost about 77lbs to date. I started having belly pain back in June which I thought was gall related. It happened again a few weeks ago , I finally called my surgeon and after numerous studies, my surgeon felt it was necessary to do a lap. I had it done last Thursday, they repaired a large Peterson's hernia and also took out my GB. I still feel crappy, really bloated and full, is it normal? How long till I start to feel better? Any suggestions!

Hi jlw,

I actually felt really good right after, but they did not remove the gallbladder, so could be the fact that they did two surgeries on you at once. It's really hard to say because it's so soon after surgery and you can expect any number of problems  1-3 weeks after surgery.

Wish I could be of more help, I would definitely contact the doctor if it continues. Internal hernia surgery is never a guaranteed fix. There could be a second hernia -or- the disturbing of the intestines could cause a new hernia to appear (my understanding is both are *conceiveable*). So you should definitely let your doctor know if it continues.

Best Wishes,

Dave