What to Ask Your Doctor Prior to Umbilical Hernia Repair

November 21st, 2011 15 comments       [ tags: ]
My impression of umbilical hernia repair

My impression of umbilical hernia repair

(You can read the update on my recovery here: My Pleasantly Uneventful Umbilical Hernia Recovery and a summary of my overall body reboot here: A Life Rebooted: Lessons Learned on a Journey to a Healthier Me)

Fair warning: this post is well off-topic from my typical Python/Django/tech focus. It does, nonetheless, share some useful information that I had a hard time compiling from Google searches alone, which is well in line with this blog’s purpose.

Next week I will be having my small and typical umbilical hernia repaired. Since this is my first surgery, I have been freaking out a bit. I have done a lot of Google searches looking for recovery stories and similar cases to mine. I have been particularly interested in the benefits of open vs. laparoscopic surgery as well as the mesh vs. suture repair method.

Over the past few months, I have been doing a lot of intense home boot camp fitness routines and am eager to learn what the recovery time for my umbilical hernia repair will be for various activities.

Finally, after a lot of searching, I posed the following questions to my surgeon. His answers are included. For background, I am a relatively fit and active person with a smallish (about the size of a grape) umbilical hernia. My surgeon is affiliated with Beth Israel Deaconess Hospital in Boston and Needham, MA and has been doing hernia repairs for about 10 years.

Where appropriate, I have annotated his replies with my own notes in brackets. This annotated information mostly came from speaking with him on the phone.

What method will you use to repair my umbilical hernia (mesh, mesh plug, suture, open, laparoscopic)?

- I think open surgery is a better approach for your hernia. It is the simplest and lowest risk approach for your situation. [Open surgery allows him to see the defect better, more accurately secure the reinforcing mesh (if needed) and has a lower risk of damaging surrounding organs.]

Is mesh required for the size hernia I have? Would sutures be an acceptable solution?

- Mesh is used when the defect in the fascia is greater than 2-3 cm and in obese patients. [He noted that recurrence rates for mesh-repaired hernia are typically less than 5% whereas recurrence rates for suture-only repairs can be as high as 25%.]

The common complications I have read about were caused by mesh problems (mesh movement, mesh balling, infection, foreign-body rejection, scar tissue, chronic pain and “tugging”). What percentage of your patients have experienced mesh-related complications?

- Mesh movement or balling is rare with open surgery. Scar tissue occurs with any operation and chronic pain is more common with inguinal hernia surgery and with laparoscopic approaches to umbilical and ventral [or incisional] hernias. Mesh infection is the most common complication. It happens in less than 1% of patients. I have done more than 2,500 hernia operations in 10 years in practice so of course I have had this complication.

Do you do any non-mesh umbilical hernia repairs? Why not for my case?

- Yes, we may still not use mesh pending the size of your defect which cannot be determined until surgery because you have some fat trapped in the defect preventing measurement until surgery.

Do you do laparoscopic umbilical hernia repairs? Why not for my case?

- Yes, I think that open surgery is a better approach for you hernia and your body type. [He noted that laparoscopic surgeries are actually more invasive than open surgeries with a greater risk of surrounding organ damage and mesh placement and movement problems.]

As mentioned above, I’m very concerned about mesh problems and chronic pain during my future P90X, boot-camp-style exercises. Which repair method is better for quickly returning to a very active lifestyle (sutures vs. mesh, open vs. laparoscopic)?

- Neither approach will prevent returning to full activity. However, you will need at least 4 weeks of rest from intense core work.

If mesh is recommended, would laparoscopic provide for a shorter recovery time? Is there a downside to a laparoscopic procedure?

- The downside to laparoscopy is that is “more invasive” even though we call it minimally invasive. We make incisions away from the hernia. There is more risk albeit small of bowel or vascular injury with laparoscopic surgery than with open surgery.

How big is the piece of mesh you will insert? What shape? What prevents it from moving? Will scar tissue form around it causing problems?

- The mesh size depends on the size of defect. It is usually 2-3 cm larger on all sides than then defect. We secure it in place with stitches and this prevents it from moving during tissue ingrowth/scarring. You want scarring and ingrowth to occur to prevent long term shifting of the mesh.

Will the incision be hidden within the navel? I don’t want a visible scar, and want my innie back.

- The incision will be small in a curvilinear fashion just below the umbilicus. It will be visible but small. You will have your “innie” back. [He noted that some surgeons completely hide the incision in the navel, but he has found that it is more difficult to aesthetically reconstruct the belly button when you do this.]

Is it possible to do local anesthesia plus IV sedation instead of general anesthesia?

- If the anesthesiologist agrees then we can do it under iv sedation with local. [The thought of general anesthesia scares me, as well as the potential for respiratory complications and throat irritation from the required breathing tube.]

What are my chances of getting chronic pain from a hernia mesh?

- very small in this location, less than 0.5% [Although he did say that I will be aware of the repair, but it shouldn't be painful.]

How is mesh-caused chronic pain treated and can it be reliably cured?

- Most chronic pain syndromes are in a different location hernias but are treated in multiple ways including mesh removal

What is your recurrence rate with non-mesh hernia repairs?

- It depends on many factors. Size of hernia, medical problems of patient, obesity etc. I would say that in your case the risk of recurrence is between 5-10%.

Umbilical hernia recovery times: how soon can I return to normal exercise activities?

Running: 2-3 weeks
Weight lifting: 4-6 weeks
Push-ups: 4 weeks
Ab crunches: 4-6 weeks
Skiing: 4 weeks

How soon can I drive?

- usually 48 hours after surgery and when not taking narcotics for pain.

How soon can l comfortably travel internationally (5 hr flight, 40 lb luggage, lots of walking, stairs)?

- 2-3 weeks

How soon can I comfortably go out socially (dinner, drinks)?

- 1-2 weeks [If I require narcotics to manage the pain, then I can't drink alcohol while taking them.]

How many times have you performed this surgery?

- all hernias 2,500-3,000 times

What kinds of complications are there to this procedure?

- bleeding, infection, recurrent hernia are the most common complications.

What kinds of complications have your patients experienced?

- all of the above albeit uncommon.

I hope this helps at least one reader become more educated about, and comfortable with, umbilical hernia repairs. I will post a follow-up after my procedure and recovery. Here are a few websites I found useful when researching umbilical hernia repair:

Now back to coding :)

SEE MY UPDATE: My Pleasantly Uneventful Umbilical Hernia Recovery

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