help please, internal hernia

OK started looking into plastics.  Had a follow up with my RNY surgeon a couple weeks early due to occasional but VERY intense abdominal pain which he says is an internal hernia.  I am scheduled to have him repair it on 9/22. 

BUT, I know that some people combine a procedure like this with some of their plastics, in this case a tummy tuck.  The issues are numerous for me though - my RNY was done about 3 hours from where I live.  I was planning to do plastics locally.  Logistics- can I really get the TT when he repairs the hernia, IF I were able to find a PS in that area (Indy if anyone is familiar with PS in the area)?  Is it worth pushing the hernia repair further out to try to do this?  I would love to save the money by combining because I will be self pay.  Also, I am guessing that the recovery from only doing the hernia repair will be nothing compared to TT recovery?  I am self employed and no matter what procedure I have done, will always be working a few hours a day as soon as I can hold my head up and type......even did after my RNY.

Coordinating a TT with almost no notice seems unlikely, expecially from out of town....having someone local to me repair the hernia is another thought, but I guess I prefer my original surgeon do it. 

Any objective thoughs and advice appreciated.

Run all of this by your surgeon, he (his office) may be able to coordinate this easier than you think, particularly if you are a self pay.  But internal hernias are very serious business so do not delay getting it taken care of.

Well it actually occurred to me to run that by the surgeon and he dismissed the idea......

Is waiting until 9/22 acceptable?  The more I read, the more nervouce I get.....but my surgeon id on vacation in the first part of Sept, and that is about the soonest they could schedule me.  On the other hand, I have had this pain occasionally for several months so maybe waiting a few more weeks is OK....sheesh, this complication business is irritating!

I am not a medical professional.  But it is my understanding that internal hernias can get strangulated and that is pretty serious stuff.  I know of a couple different WLS who have coordinated hernia repairs with a plastic surgeon.  Perhaps you could back into this by having a consult with a plastic surgeon and asking if he/she can coordinate with a general surgeon to do the hernia repair or even do the hernia repair themself.

Yeah, that is what I am looking into....but I think I am going to end up just putting off plastics.  I have not been at a stable weight yet, still losing, and I don't think I can coordinate gettting it all put together quickly enough....I think I am already waiting longer that I feel comfy with to get the repair and I guess I don't want to delay it further.  I also really need it to be 2010 before I do plastics, so I can contribute more to my HSA to cover....

Thanks for your response! 

The IRS generally doesn't allow HSA/FSAs to cover plastics.

Oh, crapola!  I never really gave that much thought.  :-(

Hi. It sounds as though you have several reasons to consider putting off plastics for awhile.

I had two patients who developed internal hernias after tummy tuck or body lift, within 3 weeks after surgery.  I reported these cases at the Texas Society of Plastic Surgeons meeting and we agreed that the muscle tightening done at the time of tummy tuck may contribute in some cases to internal herniation. 

How the original WLS was done is of obvious importance too, and today most WLS surgeons close the hole that can let the intestines slip through.

So my thought would be get this hernia out of the way, complete your weight loss, and you will have better but mainly safer results !

Thanks - I enjoy watching you on Big Medicine, by the way.

I hate to "lose" the opportunity I have with already being under and paying for an OR, etc., BUT it does not seem like the timing is right, and I have accepted that it just was not meant to be....it really is too early for me to get into the plastics.

Thanks again! 

Well, keep us posted and please share your symptoms with others re: the internal (Peterson) hernia.

These things can eb sneaky,  and get serious quick.

Best,

Dr. L.

P.S. I hear Big medicine 3 may be in the works.