I know I have diastasis recti but what is the best method to diagnosis ventral hernia? What test should a doctor perform?
Diagnosing Ventral Hernia?
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Doctor Answers 18
Hernia vs rectus diastasis
A physical exam can usually differentiate a rectus diastasis from a hernia but in some cases, it is hard to tell. An ultrasound is one easy way to evaluate the abdominal wall. A CT scan may also be done but does involve radiation exposure (more of a concern in a woman of childbearing age and less so in a man).
If you are asking this to see if insurance will cover the repair, then documentation of a hernia may be needed. If you are going to have an abdominoplasty anyway, then you may not need to undergo the tests as a hernia would be obvious at the time of a tummy tuck and could be repaired by a Board Certified plastic surgeon. In such a situation, you may want to get an insurance prior authorization first so that the hernia repair (if found at the time of surgery) would be covered.
How to diagnose a ventral hernia
In our practice, we perform tummy tucks in patients of all shapes, sizes, and walks of life. Many of our patients have a separation between their abdominal muscles or even a ventral hernia. During the initial consultation, we carefully examine the abdominal wall of every patient to look for separations, weaknesses, or defects in the abdominal wall such as a hernia. If the patient has a large hernia or if this hernia has recurred, it may be necessary to obtain the advice of a general surgeon who can repair this hernia at the same time that we perform a tummy tuck. It is essential to plan ahead for this as this may change the operative plan and the management of the umbilicus as well. Be sure that you are only working with a plastic surgeon that is board-certified by the American Board of Plastic Surgery and has a great deal of experience in abdominoplasty, liposuction, and body contouring.
I can usually diagnose these ventral hernias on physical exam by having the patient stand up and strain. There is usually a palpable edge to the tear in the fascia and I can feel the bulge of the hernia. It often falls back in when the patient is supine. I have done a zillion abdominoplasties and true hernias are quite rare. More common in a really, really thinned out fascial layer, sometimes paper thin, but no true hernia sac to reduce. This may seem a moot point and surgically it usually is but if a patient and their surgeon are trying to get some insurance coverage for the procedure and no true hernia exisits and can be an issue for payment. I often have patients with small umbilical hernias that are obvious preabdominoplasty. These are easy and quick to fix and I do not charge extra or get insurance involved unless the hernia is causing symptoms (very rare).
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How to diagnose a ventral hernia
A hernia is an actual hole in the fascia and muscle. I examine my patients for a hernia, while they stand. Also, sometimes a CT scan is helpful to measure the size of the hernia and evaluate the muscles.
Ventral hernia versus a rectus muscle diastasis
A hernia is a true defect of the abdominal wall typically with very discreet edges often associated with an incision. The diastasis is more broad based.
Ventral hernia, diastasis recti
This is a separation of the muscles of the tummy usually after pregancy that causes a bulging in the lower tummy usually. It is repaired during a tummy tuck but can also be helpeed with the Tupler method. Watch my videos.
Ventral Hernia Workup
If you are looking to undergo a body contouring procedure (tummy tuck or body lift) in combination with a ventral hernia repair, your plastic surgeon can often detect a sizeable hernia on physical exam. If you have a very thick abdominal wall, a CT scan may help determine the presence, size, and location of the hernia. However, It is not uncommon to encounter a small (<5 cm) ventral hernia during a tummy tuck or body contouring procedure. This can be safely repaired by the plastic surgeon during your contouring procedure.
If you are simply looking for ventral hernia repair without a body contouring procedure, I would recommend a laparoscopic surgeon to evaluate and work you up for a minimally invasive ventral hernia repair, which will allow for a quicker recovery with less downtime.
All the best in a safe recovery.
Paul S. Gill, M.D.
Gill Plastic Surgery
Houston Double Board Certified Plastic Surgeon
Do you have symptoms of a hernia?
A hernia is a defect in the abdominal wall that allows passage of the contents of the abdomen to pass. If bowel or omental fat get in the hernia it can cause pain. If the contents of the hernia do not go back in they can lose their blood supply and cause a surgical emergency.
Frequently defects in the abdominal wall are repaired at the time of abdominoplasty. It is very common in body contouring after massive weight loss.
Insurance will not cover your abdominoplasty because of a hernia but I do not charge extra if I repair it in the course of an abdominoplasty simply because it needs to be done. They may pay a general surgeon to repair a hernia separately if it is done at the time of abdominoplasty but I would check with your insurance carrier first.
Ventral hernia diagnosis
Usually the best way to diagnose a ventral hernia is by physical exam. Sometimes the physical exam does not pick it up, and you may want to consider a CT scan or MRI.
How to diagnose a ventral hernia.
Thank you for the question.
A ventral hernia diagnosis is fairly straightforward and in most instances can be made quite easily on clinical examination. If you are significantly over weight or have a past history history of multiple abdominal surgeries, a CT Scan may be indicated to better delineate your anatomy.
Glenn Vallecillos, MD, FACS
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.