TT with previous Mesh Hernia repair. Any issues?

Hi folks,

I'm only 11 months out from my RNY but I'm below my goal weight and I've been stable for about 2 months now.   So, I'm beginning to think about some reconstructive surgery but I have a few questions.  I've been lurking here for a couple of weeks and figure now was the time to go ahead and ask the questions.

Background:
a) Male 49 years
b) Laproscopic RNY done 3/25/09 -- lost 134 lbs
c)  current body fat percentage 17%
d) Had emergency splenectomy (open) 11 years ago and 7 incisional hernias repaired 1 year after that.   8in x 8in mesh inserted through original splenectomy incision.
e) RNY surgeon repaired another ventral hernia while she was in doing my RNY.
f)  Surgeon said I had "significant adhesions" from the previous surgeries.   She had to "take them down" (her term) before she could get to my RNY.
f)  I've got 2 other small hernias that have formed in the pannus and will have to be repaired.   Surgeon wanted to discuss that at my 1 year RNY follow-up (1 month from now).


I expect that insurance will pay for the hernia repair but I don't meet their requirements for a panniculectomy (haven't had the skin issues).  So, I am thinking about an abdominoplasty at the same time as the hernia repair and will pay out of pocket for that.

Questions:

1)  Is an abdominoplasty even feasible given the previous sternum to belly button incision that has been opened up twice and had 8x8 mesh inserted?

2)  If the answer to (1) is yes, will they remove the mesh and tighten up the muscles or will the mesh stay in?

3)  If the answer to (1) is no, what other options do I have?

Thanks in advance for your help.

You will be a challenge, but should have a decent result.  Since I am trained as a general surgeon too, I usually undertake these cases without calling in a general surgeon.  My experience dates back to the time when most if not all cases were being done open, not laparoscpically, so I see a lot of cases where hernia, scarring, and mesh are an issue.

The question is the relation of the hernias to the mesh, and the degree of scarring in the mesh.

Only a CT scan of your abdomen will reveal what is going on, and will provide your doc  with a "roadmap" for the surgery.

Overall, men do not require the msucle tightening, so the hope would be that the skin can be removed and tightened without much interference from the mesh.  Mesh removal is to be avoided for several reasons.

Small hernias can be fixed using your own tissues (my preference) or more mesh.

Keep us posted.

Thanks Dr. L.   I really appreciate the info.

I am female, but can tell you that I had my TT after a hernia repair that utilized a 6x6 piece of mesh.  The mesh was NOT removed and did not cause any problem with the TT.

The problem that I ran into is that -- probably as a result (or partial result) of the previous surgeries (open RNY and hernia repair) -- my TT incision turned necrotic and I ended up with a large crayer in my belly that took 6 months to heal up.

Lora

Hi Lora,

Thanks for the additional information.   I'm sorry that you went through such a struggle.   You said that it took 6 months to heal up -- any lingering issues or additional scar tissue or anything from that necrotic tissue?   Or did it just take longer to heal?

Thanks

The scar from the wound left when he cut out all the necrotic tissue now looks like a "T"-shaped burn under my breasts and part of the way down my middle.  It's not very attractive, but it's smaller than I expected and at least most of it is hidden under my breasts.  The area along the vertical incision line is somewhat "hard", so I image it is scar tissue.  I also have a large area with limiited or no nerve sensation in the skin.

Mostly, it just takes a really long time for it to heal (and it's a pain in the butt to clean and pack for months and months) because it has to heal from the inside out... until the body regenerates the tissue up to the normal level (filling in  the hole), none of the skin grows back... so the wound stays very large for a very long time.

Lora

Hi Lora,

Thanks so much for the additional information.   Just wanted to know what the possibilities were.  Always best to go into things with "eyes wide open".

Thanks so much.