My surgeon wishes to perform a polyfiber mesh inplant using minimal invasive surgery, but I have been told this should be done as a last resort due to possible high degree of infection. NOTE: My surgeon has not performed a CT. What is the proper repair for these issues that my insurance will pay for. My insurance will not pay for a tummy tuck, but I am not having it done for that reason. How can the Rectus and Ventral hernia repair be done so it is not considered cosmedic surgery? thanks
I'm a 65 Male with Rectus Diasthasis and I Also Have a Ventral Hernia. Best Way to Repair?
Doctor Answers 4
Ventral hernia repair without mesh.
A safe and effective option for ventral hernia repairs without mesh is an operation known as a separation of components. Essentially, the abdominal wall consists of multiple layers of "fascia." Each fascial layer is very strong and associated with the muscles of the abdominal wall. By separating the fascial layers from one another and using these to close off the hernia, both the hernia and the diastasis are repaired. This is not a tummy tuck, but rather a repair of an abdominal hernia. This operation avoids the use of mesh which obviously eliminates the issues with mesh infection. Component separation is a well known and accepted method of repairing ventral hernias, although preauthorization with your insurance carrier is recommended. If you were to add a skin excision component to the procedure, this is usually considered cosmetic unless the skin is a true pannus and you have symptoms such as maceration or infections underneath the skin.
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Ventral hernia and diastasis are reconstructive/ tummy tuck is cosmetic
You have a ventral hernia and diastasis which should be covered by insurance. The choice of hernia repair is determined by your surgeon. Factors in deciding technique include the size and location of the hernia (suggesting that a radiological exam may be of benefit), previous operations on the hernia, and previous use of mesh or only suture repair. If you have had previous mesh and infection, this may obviate the use of mesh again.
Depending upon where and how large the hernia is, different incisions can be used to gain access ( midline, transverse, or low abdominal). A tummy tuck or abdominoplasty incision can be used to give excellent exposure of the diastasis and the ventral hernia from the rib cage down to the pubic area, allowing a very strong hernia repair.
Since the hernia repair is done for reconstruction, it should be covered by your insurance. If an abdominoplasty is done at the same time, it may or may not be a covered procedure by your insurance. You would have to check the stipulations in your policy before proceeding with the abdominoplasty. Otherwise, it would be considered cosmetic. Nonetheless, you could have BOTH a reconstructive and cosmetic procedure done during the same operation.
A one on one exam by a board certified plastic surgeon will help to clarify some of these issues. Good Luck!
Ventral hernia repair and rectus diasthasis repair
The skin incision to access the hernia repair is only access route. Whether it is through a midline incision abdominoplasty incision or a laparoscopic incision you must access the hernia to repair.
The severity of hernia would determine if a closure of the hernia, or repair using mesh or a direct closure and then a mesh on top of the closure would be the best way to close this hernia. I don't believe the rectus diasthasis can be repaired laparoscopically.
If the hernia can be suture approximated and the mesh placed on top this may give you the strongest repair.
There are many types of material that can be used as a mesh some of these materials can even be used infected wounds not all mash up prone to infection.
It is best to discuss the repair with you Dr. and review the pluses and minuses of each method of repair. A CT scan would not hurt and may help to decide on the type of repair it might be best. It sounds like he's left questions about the procedure you should review all the information with you Dr. so on your questions are answered before surgery.
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Tummy tuck with mesh
Whether you need a tummy tuck or not is irrelevant to the decision as to how the rectus diastasis and hernia is repaired. The repair of the diastasis can be done with or without an accompanying tummy tuck. If your skin is loose or hanging, a tummy tuck would be a good idea. If not, the repair is enough.
As for the method of diastasis repair itself the advice i have is that in males if required it needs to be strong. If not strong, it can give way at least in part creating a recurrent bulge. IF this occurs it's usually in the upper abdomen where the forces seem greater. The stitches themselves don't give way - but they are only as strong as the tissue they're being put into. And the reason often for the diastasis in the first place is that the supporting tissues are not strong.
So, I assess this at operation. But all my male patients are consented for mesh and I often use it for added repair strength.
Any implantable mesh or device has a chance of infection. But if you're well, the infection rate is extremely low. I wouldn't worry about that. The infection risk ( presuming you're well and not immunosuppressed) is less than 1%. Even of it got infected, it then just needs to be removed. I've never removed mesh from an elective diastasis repair in 20 years of practice.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.