Ventral hernia repair/panniculectomy at the same time?

Question

I have lost 90 lbs and have beef diagnosed with a ventral hernia in my lower abdomen. Can a panniculectomy be performed at the same time? My insurance will cover the panniculectomy if the hernia is located in the same area and/or there is a chance the loose skin could cause bacterial seeding

Ross Blagg, MD · Answer

Hello,
Typically, you can have both repaired at the same time. An in-person exam would be required to know for sure. 
All the best!
Dr. Blagg
Austin, TX

Karthik Ram, MRCS, DNB · Answer

Hello, Thanks for sharing your query. Yes both can be done in same sitting as both are clean surgeries. Repairing only lower abdomen hernia with can cause upper abdominal bulge so ideal would be to plicate entire length of rectus like in tummy tuck. Consult a board certified plastic surgeon.

Remus Repta, MD · Answer

When properly planned, a panniculectomy and hernia repair can be done at the same time.  It is important to know that tightening the lower half of your abdominal wall can make the upper half bulge our a little if the tightening is done too much.  This is important to keep in mind since the hernia repair cannot take the place of abdominal wall tightening that is done during a tummy tuck.Dr. Remus Repta

Abdulla Fakhro, MD, FACS · Answer

Hello, it is often difficult to determine your specific query without examining you. A ventral hernia is usually a result of prior surgery with now weakened abdominal wall musculature, if you presented with pain and are having issues related to the hernia (this can also vary and depend on the size of the hernia and what's in the hernia ie. is there any bowel in it that is just sitting there and causing you constipation or an upset tummy?) a CT scan will often tell you that, but not every physician will deem a scan necessary. sometimes your clinical symptoms are history/physical are enough to determine that.
The panniculectomy is often covered by insurance as it is considered a medical necessity since the skin can get repetitively infected (intertrigo/cellulitis), sometimes even presenting as boils or soft tissue infections (especially in the warmer or subtropical climates). The panniculectomy performed can be performed with the ventral/incisional hernia repair as a medically necessary procedure if there there is or has been any soft tissue or skin that was or is infected anywhere near the hernia, especially if there is any consideration for mesh placement (this depends on the size of the hernia on exam or on ct). Placement of mesh near any tissue that may get infected can risk infecting the mesh subjecting you to another infection or further surgery for removal of the mesh. The types of mesh vary with surgeons preference but the majority of surgeons will now use a form of a bioprosthetic or absorbable mesh.
I would advise you to talk to your surgeon about the necessary insurance paperwork before you undergo surgery, they are very understanding even if they have a few more questions or need further tests such as a CT scan to approve the surgery. Again this is case dependent and not all cases are the same. I hope this has helped answer some of your queries. Hope your surgery goes well!

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