Can I have a tummy tuck with abdominal wall adhesions?

Question

is it possible or advisable to have a tummy tuck with a history of endometrial and/or surgical adhesions, if the adhesions are sticking organs to your abdominal wall? from what i understand it can be difficult the know the extent of adhesions without going in there surgically. a diastasis recti repair should not disturb the adhesions? or is there the possibility of that surgery creating more?

Tek Przylecki, MD, FACS · Answer

Thank you for your question. Unless you have a complex hernia with a defect in the abdominal wall, intra abdominal adhesions, like one might have from endometriosis and inflammation would not preclude you from tummy tuck. . A tummy tuck is performed on the outside of the abdominal wall and should not affect/impact intra-abdominal adhesions.I recommend a consultation with a board certified plastic surgeon. Best of luck on your journey!

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your interesting question regarding whether you can have a tummy tuck with a history of anterior abdominal wall adhesions. I’m sorry you have adhesions from endometriosis as well as surgical adhesions. When surgeons refer to adhesions, we are usually referring to scar tissue in the peritoneal cavity. When surgeons describe adhesions to the anterior abdominal wall, we are referring to scars inside the peritoneal cavity on the anterior, dorsal (or frontal, where your belly button is located) wall. The peritoneal cavity is a body part that contains the liver, gallbladder, and small intestines, among other things. Typically, adhesions are scar tissue around the small bowel or small intestines. Adhesions can cause abdominal cramping and twisting of the small intestine. Adhesions can also cause incarceration and hernias, which may necessitate emergency surgery to release the adhesions. This surgery is called lysis of adhesions. However, remember the peritoneal cavity is behind the rectus abdominis muscle. Fortunately, when performing a tummy tuck or abdominoplasty, the peritoneal adhesions are not disturbed. Some of the adhesions may have adhered to the posterior or back wall of the rectus abdominis muscle. Therefore, during rectus abdominis muscle plication, some of these adhesions can become disturbed. Rectus abdominis diastasis correction should not create any more intra-abdominal adhesions. However, most experienced plastic surgeons would agree not to correct the rectus abdominis diastasis for fear of disturbing intra-peritoneal contents. However, if the rectus abdominis diastasis is severe, it will likely require correction. This requires further investigation through physical examination and/or CT scan or MRI. Therefore, you can undergo a tummy tuck with a history of endometrial and surgical adhesions. However, most plastic surgeons would not perform rectus abdominis muscle plication during the tummy tuck. Thank you for your question regarding whether you can have a tummy tuck with abdominal wall adhesions. Good luck! Sincerely, Dr. Katzen, MD, MBA. (Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Danielle Dumestre, MD · Answer

Good news! Tummy tuck will not affect or worsen abdominal adhesions. A diastasis recti repair simply closes the gap between your vertical ab muscles, known as the rectus abdominis. This repair is done carefully to include the outer layer of the fascia, which you can picture as a ‘casing’ around the muscles . The repair does not go deeper than that and will not touch any of your intra-abdominal organs.

Eric Swanson, MD · Answer

When doing a tummy tuck, the surgeon does not enter the abdominal cavity, so there is no risk of causing adhesions between abdominal organs. This is also true when performing a diastasis rectus repair.

James Knoetgen, III, MD · Answer

You’re absolutely right to be asking these questions – abdominal wall adhesions, especially from endometriosis or previous surgeries, do complicate the picture. Let’s go through this carefully: 
1. Can you have a tummy tuck with abdominal wall adhesions?
Yes, it’s possible – but only with careful surgical planning. 
•	Adhesions that stick organs (like bowel, bladder, or uterus) to the abdominal wall are a major concern because the dissection involved in a tummy tuck may disturb or accidentally injure those organs. 
•	Surgeons can encounter adhesions during the procedure and carefully work around or release them, but this increases the risk of complications such as organ injury, bleeding, or infection. 
•	A combined team approach (plastic surgeon + general or gynecologic surgeon) may be advisable if known or suspected extensive adhesions are present. 
2. Is it advisable if the adhesions are from endometriosis or prior surgeries?
It depends on the severity and symptoms: 
•	If adhesions are extensive and symptomatic (causing pain, bowel issues, etc.), a diagnostic laparoscopy or other imaging might be considered before committing to abdominoplasty. 
•	A tummy tuck is an elective procedure, so the risk-benefit ratio must be carefully considered. In some cases, it may be safer to address or at least map out the adhesions first. 
•	Some patients choose to have adhesiolysis (surgical removal of adhesions) as a separate procedure before or during abdominoplasty – this again depends on the extent of the adhesions and symptoms. 
3. Will a diastasis recti repair disturb the adhesions?
It can – but not always. 
•	Diastasis recti repair (usually done with suturing the linea alba) is performed on the front of the abdominal wall, so if adhesions are deeper – on the peritoneal or visceral surfaces – they might not be involved directly. 
•	However, any surgical manipulation of the abdominal wall risks disturbing nearby adhesions, especially if they’re tethering organs close to the muscle or fascia being repaired. 
•	Even if existing adhesions aren’t disturbed, new adhesions can form after surgery – this is a known risk with any abdominal operation. 
In summary: 
•	Yes, you can potentially have a tummy tuck, even with adhesions – but you need a surgeon experienced with complex abdominal cases. 
•	Pre-operative imaging (CT or MRI) may help, but the full extent of adhesions is often only visible during surgery. 
•	Diastasis recti repair may or may not impact adhesions, depending on their depth and location. 
•	Yes, more adhesions can form as a result of surgery. 
What you can do: 
•	Seek a plastic surgeon with experience in post-surgical or post-endometriosis cases. 
•	Request a pre-op imaging study (like MRI with contrast or CT scan) to get a better idea of adhesion location. 
•	Consider a collaborative approach between plastic surgery and a gynecologist or general surgeon.

Can I have a tummy tuck with abdominal wall adhesions?

Answers (5)

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