Abdominal Wall Reconstruction- experiences?

[Settledownnow]

@Jbandmmomma I was wondering if you have any post-op photos you wouldn't mind sharing? Is your "baby" gone or do you still have some lumps from the reconstruction? Did the general surgeon work with a plastic surgeon?

 

[Jbandmmomma]

Hi,

No plastic surgeon involved - I didn't have the resources and the hernia was only getting worse. I still have the pannus from 3 C-sections and WLS. I will look for the pictures. The surgeon did take excess skin and tissues down the length of the incision. I ended up with a pretty flat stomach from breastbone down to lower abdomen (which looks strange with the pannus, but I will live with it for now.)

becky

 

[Charris]

Hi,

No plastic surgeon involved - I didn't have the resources and the hernia was only getting worse. I still have the pannus from 3 C-sections and WLS. I will look for the pictures. The surgeon did take excess skin and tissues down the length of the incision. I ended up with a pretty flat stomach from breastbone down to lower abdomen (which looks strange with the pannus, but I will live with it for now.)


becky

well that's crazy why would he not just take that off. Dr. God forbid if they do anything that makes since if they can get more money for it later. I'd be PISSED. It reminds me of those who do the abdominalplasty and don't pull up your girl parts leaving women LOOKING like a man. It just seems like have some pride and do the best job you can. When i had WLS the 1st time I knew 4 women left looking like that. I told my dr. if he left me looking like that we were going to have some problems. Which reminds me I didn't mention to Dr K to make sure if she looks a little slouchy to make sure to pull her up. Ugggh. I know with his perfectionist ODC self will definitely want me looking good after being touched by him. lol

 

[Settledownnow]

I've now had a third consult with a surgeon and am officially stressed out by choosing a surgeon and having surgery. I have canceled my surgery that was to be done next week and ruled out that particular surgeon. That leaves 2 possible surgeons now.

I went to the Cleveland Clinic (about 4 hours from here) and saw "one of the best surgeons in the country" and "people come from all over the world to see me" guy. He does at least 100 of these surgeries every year. Then, I met with another surgeon at another large medical center about an hour from here. She is experienced in complex hernias and AWR but also does other types of surgery. I decided to sleep on it and hoped a decision would come to me.

I believe I am going to go with the woman surgeon who is closer to home based strictly on intuition and her bedside manner. She is very detailed oriented, took lots of notes while she interviewed me about my medical history, spent a lot of time with me, explained the surgery in detail, drew pictures, told me her partner (gen. surgeon) would be the extra pair of hands during surgery (surgery is 5-6 hours long), informed me of possible concerns she had (i.e. wound healing based on my history) and how she would handle any potential complications (transfer me to the downtown hospital and put me in ICU).

My brain wants to go to the best at Cleveland Clinic but the surgeon was rushed, didn't have time for me, and had students/residents with him. He never read the letter I gave him from Dr. K. It was thrown to the side. I needed more details and explanation on the techniques he would use and the size and type of mesh. Still, his statements echo in my mind that I have "a very large hernia", "this is a huge operation" and "you have only one shot to get this right" and, "you need to be at the Cleveland Clinic and get it done right." Logistically and financially it will be a strain, plus he does not have any surgery openings until October. I am physically uncomfortable and my hernia is getting larger. I believe the resident that was with him will be assisting because I heard them talking in the hall about me. The surgeon said to the resident, "should we do this surgery?" and "she seems like a nice woman." He says he can get my stomach flat. The woman surgeon says she knows she can get the protrusion down by at least 50%, maybe more, but it depends on what my muscles look like on the inside. She explained that my muscle is split up to my ribs and she will need to watch me in surgery to see if I have respiratory distress from the muscles being pulled too tightly and would adjust according to my breathing patterns.

Often my "gut" feelings are right, but I am second guessing myself. To cover my bases, I signed consents for surgery at each place -- ha!

Any insights?

 

[Clematis]

Just a few comments...

It's not the hospital system that's important, but the individual surgeon.

Also a doc is not more knowledgeable just because s/he is "Department Chair", often a political appointment -- the other docs may have been too busy being doctors to want to deal with the BS of managing the department. (I'm guessing you spoke with Rosen?)

The Cleveland Clinic is a BIG BRAND known particularly (and deservedly) for heart. "Brands" don't necessarily translate to quality per individual physician or specialty. (I have no specific knowledge of their hernia surgeries.)

If you have researched and feel both hospital systems could deal with possible complications from "a huge operation", and both physicians are equally competent, chose the doc with whom you can communicate best.

Good luck with your decision.

 

[Settledownnow]

Just a few comments...

It's not the hospital system that's important, but the individual surgeon.

Also a doc is not more knowledgeable just because s/he is "Department Chair", often a political appointment -- the other docs may have been too busy being doctors to want to deal with the BS of managing the department. (I'm guessing you spoke with Rosen?)

The Cleveland Clinic is a BIG BRAND known particularly (and deservedly) for heart. "Brands" don't necessarily translate to quality per individual physician or specialty. (I have no specific knowledge of their hernia surgeries.)

If you have researched and feel both hospital systems could deal with possible complications from "a huge operation", and both physicians are equally competent, chose the doc with whom you can communicate best.

Good luck with your decision.

Yes -- it was Rosen. His nurse just called me to schedule, but I missed the call. You mentioned some good points to consider. Thanks for your perspective.

 

[Clematis]

One more thought which may complicate the decision:

Is your hernia particularly unique? Having zero experience with hernias I don't know if yours is or is not (looks pretty remarkable to me!!) but if Rosen says it's "a huge operation" is he suggesting that this is an unusual surgery in its scope? If so, I might go for the BIG hospital system. I do have experience with people who have had surgery at CCF for something particularly unique and/or complicated and it seemed EVERYONE came to participate in and/or watch the surgery and visited the patient before and after. As a teaching hospital, the young docs L-O-V-E learning about the tricky cases. That many eyes on the prize can only help the outcome, I believe.

 

[Settledownnow]

One more thought which may complicate the decision:

Is your hernia particularly unique? Having zero experience with hernias I don't know if yours is or is not (looks pretty remarkable to me!!) but if Rosen says it's "a huge operation" is he suggesting that this is an unusual surgery in its scope? If so, I might go for the BIG hospital system. I do have experience with people who have had surgery at CCF for something particularly unique and/or complicated and it seemed EVERYONE came to participate in and/or watch the surgery and visited the patient before and after. As a teaching hospital, the young docs L-O-V-E learning about the tricky cases. That many eyes on the prize can only help the outcome, I believe.

I do not know if it a "unique" a hernia but rather large. He also said it would take 5-6 hours to repair. He did say that I only have one shot to get this done right and that is what gives me pause. The other surgeon is with Univ of Cinn Health Center. It is apparent he likes teaching because I could hear him quizzing and joking with the residents/students in the hallway about the DS configuration. He said, "Oh come on, my daughter could tell me it was WLS. What else?"

 

[Settledownnow]

It was also interesting to learn that he felt plastic surgery for any skin removal would increase the risk of infection and preferred to stage the surgeries. He did say after this surgery was done he would "fix me up" with a plastic surgeon at CCF. I really do not have much extra abdominal skin but I will need other repairs done.

 

[Susan in Tennessee]

It was also interesting to learn that he felt plastic surgery for any skin removal would increase the risk of infection and preferred to stage the surgeries. He did say after this surgery was done he would "fix me up" with a plastic surgeon at CCF. I really do not have much extra abdominal skin but I will need other repairs done.

What a tough decision! The part that stood out to me was you said that HE said he could give you a flat stomach whereas the female surgeon claimed she could get 50% of your protrusion to go away. Big difference. Would you be satisfied with a 50% improvement?

 

[Clematis]

Susan makes a very good point. And I kinda glossed over that in the first reading.

The female surgeon is saying she might only be able to do 50% reduction because repairing your abdominis recti could hamper your breathing when your guts are moved from their palatial quarters to the space they are intended to occupy? (And you only have a crescent of a stomach left so there should be plenty of room.)

Rosen is sounding better...

 

[Settledownnow]

What a tough decision! The part that stood out to me was you said that HE said he could give you a flat stomach whereas the female surgeon claimed she could get 50% of your protrusion to go away. Big difference. Would you be satisfied with a 50% improvement?

No, I would not be. That is the problem. She is not the first surgeon to tell me this and it makes me wonder if the other surgeon says he could get my stomach reasonably flat (take down 85% of the bulge or even up to 95% in a year after healing is complete) because he has done so many that he can tell based on my CT results and my exam. Or, does he do something different? She said the problem is the location because she would have to rebuild the muscle up near my ribs and if pulled too tightly would squeeze my lungs and I would go into respiratory distress. She said she can get my stomach flat, but I have to be able to breathe on my own, lol. She said she could (get ready) start the surgery and allow my muscles to stretch for a day or two while keeping me intubated (unconscious) in ICU for 1-2 days. Then finish the surgery. I said, "no thank, you".

 

[Settledownnow]

Susan makes a very good point. And I kinda glossed over that in the first reading.

The female surgeon is saying she might only be able to do 50% reduction because repairing your abdominis recti could hamper your breathing when your guts are moved from their palatial quarters to the space they are intended to occupy? (And you only have a crescent of a stomach left so there should be plenty of room.)

Rosen is sounding better...

Yes, exactly. I have plenty of skin and room to repack my organs into the correct space but the concern is the quality of muscle available. She said if she were dealing with my belly it would not be a problem, but since the hernia up near my ribcage it is more challenging.

 

[southernlady]

Okay, back in 2004, Dh had a stroke. But not officially as no one called it that. However, losing control of half your body suddenly screams stroke. Esp since he had 8 documented TIAs after.

Where am I going with this?
Our neuro was unsure and wanted him to see a specialist at the Cleveland Clinic along with brain MRI. So we traipsed off to see him. The neuro there was SO focused on his weight that he failed to focus on the issue. He was also convinced that someone overweight could not have normal cholesterol (like that had a damned thing to do with the possibible stroke. We went back home frustrated. We were also told all he had was a "complicated migraine".

I trusted my gut that he was not the same but not sure why so made another appointment with a third neurologist. Turns out, the third one found he had Normal Pressure Hydrocephalus based on that SAME brain MRI (unheard of in people younger than 60 and he's just now 56).

He still had had the stroke and it wasn't until he had the DS and got his blood pressure under control that the TIAs stopped.

So no, the words Cleveland Clinic is NOT magic, not the be all of hospitals.

My suggestion, trust your gut.

 

[Charris]

Hum @Settledownnow what percentage did dr. K say he could get your stomach down?