Hi Im going in for surgery on Tuesday. Im afraid my Dr. stated that I had hernia and when I went to see this general surgeon he said that I had diastasis recti and that he was gonna cut me up and down above my belly button, tuck it and put some mesh on it. I have been trying my best to get some answers and I havent found any and Im really scared. All I wanna know is if you can die from this surgery and what are the after effects?
Can You Die from Having Surgery on Your Diastasis Recti?
Doctor Answers 7
Let me assure you that your fear is normal. Fear typically comes from lack of education about the subject. I would advise you to consult with your board certified plastic surgeon regarding your questions and concerns. You may find it easier to reach your surgeon's nurse who should be able to answer your questions and put you at ease thus eliminating fear. Best of luck!
It is normal to be worried
It is normal to be worried before surgery. In most cases, it is the first time you will be in an operating room and, with cosmetic surgery, you are not sick or in dire need of the surgery. It is an elective process that you are choosing to do. With a diastasis recti, you do not need to be cut "up and down" by the general surgeon. Your plastic surgeon can repair your diastasis through an abdominoplasty (tummy tuck) incision. If your plastic surgeon is also trained in general surgery, then they can also repair any hernia, if present. It is good that you are seeking as much information as possible before surgery. However, try not to freak yourself out.
A plastic surgeon can repair the diastasis with the tummy tuck
I'm surprised you are seeing a general surgeon. Most experienced plastic surgeons can repair a diastasis recti (splaying of the rectus muscles) at the same time as the abdominoplasty. General surgeons tend to leave scars on the abdomen. Plastic surgeons are trained to hide the scar below your bikini line. Usually mesh is not necessary unless you have a very unusual situation. You may wish to get an opinion from another surgeon, preferably a plastic surgeon who can attend to the diastasis and also give you the best cosmetic result. Yes, you can die from having surgery. That's why you need to go to an experienced surgeon who is well-qualified and a facility that is licensed or accredited. If you do that, your chances of dying from the surgery are remote. I have attached a link for more information. The more you know, the less anxious you will be.
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Fear of dying with diastasis recti repair or hernia repair.
You need to speak with your surgeons, for you seem to have unfounded concerns, as well as misunderstanding of the exact problem(s) and proposed solution(s). Let's do a bit of basic explanation first.
Diastasis recti is stretching of the rectus abdominis muscle sheath (the gristle or fascial layer that surrounds the six-pack muscles in the abdomen). These muscles are the ones that are stretched apart with pregnancy, obesity, and occasionally other rare conditions such as collagen disorders. A hernia is an actual tear, rip, or hole-like opening in this sheath, through which fat or even loops of intestine can protrude, depending on the size of the hernia. Frequently with pregnancy women develop a small umbilical hernia, and their belly button becomes an "outie" instead of its former "innie." When these are small and asymptomatic, they are only cosmetic annoyances and are routinely repaired by any ABPS-certified plastic surgeon during cosmetic abdominoplasty or tummy tuck.
When there is a larger umbilical hernia, a loop of intestine could become entrapped in your hernia, causing strangulation of the bowel, loss of circulation, possible perforation, peritonitis, and severe repercussions, including death. While this is rare, this is why large(r) hernias are repaired, and are covered by insurance. This also applies to splits in the fascia (hernias) other than at the umbilicus. Depending on size, same potential risks and same recommendation: REPAIR.
If your hernia is large enough to require (or recommend) mesh reinforcement, perhaps this is why your plastic surgeon has asked for the participation of a colleague general surgeon.
Many plastic surgeons are fully trained and board-certified general surgeons, as they completed this training before sub-specialty training and board-certification in plastic surgery. While they may never practice the full range and scope of general surgery once they become plastic surgeons (and may not renew their certification in General Surgery), we do not "forget" our ability to do this type of abdominal wall repair. In fact, when general surgeons are unable or fail in their attempts to repair abdominal wall hernias (some of them massive), they call on plastic surgical colleagues to perform more advanced reconstructive techniques than repair alone, or repair and mesh reinforcement. This is part of our plastic surgery training and our own certification.
However, some plastic surgeons come from an ENT, or orthopedic surgery, or urology background, and despite full training and certification in plastic and reconstructive surgery (or simply because they want to let the reconstructive portion of the abdominal wall hernia repair be performed by a general surgeon, and be reimbursed by your insurance) they will ask a general surgical colleague to step in and do this portion of your cosmetic tummy tuck. It may not even be a training or background issue, it may simply be the way referrals are taken care of in your hospital or by your surgeons.
There ARE slightly higher risks of infection or re-operation when mesh hernia repairs are done in conjunction with cosmetic tummy tuck. These are significantly higher if you are a smoker, use any nicotine products (including gum, spray, or patch), or even are exposed to second-hand smoke!
You should not be afraid, but this reassurance should come from both your general surgeon and your plastic surgeon. They owe it to you to explain to your satisfaction just what is being done, by whom, and with what risks. Please call them both tomorrow, or reschedule surgery when all of your questions are answered.
Complications from abdomial wall plication
Although plastic surgery is safe, especialy when performed properly there are some real risks involved. The most serious complication of a tummy tuck could be considered to be DVT which is deep vein thrombosis or bloot clots in the leg. These can dislodge and travel up to the lungs (pulmonary embolism PE). If these clots are big enough you can have serious cardiopulmunary complications including death. To minimize the chance of this patients should be evaluate for clotting problems (clotting to easily as opposed to bleeding to long). Certain medications such as birth control medications may increase the risk of DVT/PE. My protocol for my patients is to evaluate their past medical history. Keep them hydrated, used compression devices on their calfs in the operating room, use blood thinners such as Lovenox, and be efficient during the surgery procedure. In the post-operative period it is important for the patient to maintain good hydration and to get up and walk the night following surgery.
All the best,
Dr. Remus Repta,
Fear of proposed hernia repair during an abdominoplasty
The procedure that you are planning to undergo is extremely common, not of a high risk and has been performed for years as standard procedure. With that said, there are always risks for any surgical procedure no matter how minor it is. The reality is that the threat that this procedure poses to your existence is extremely small.
You should contact your general surgeon (and even your plastic surgeon) prior to your surgery so that you can have your questions and concerns answered and your anxiety (which is very common and normal) hopefully reduced.
All surgery has risks that should be discussed before surgery!
It is common to feel anxious before surgery if you still have unanswered questions. The best source of advice is always your surgeon and their team that is performing your surgery - not the internet and not your well intentioned friends.
All procedures have risks. Your proposed surgery is very common and likely to have no problems. However, your risks are unique to your situation. Each surgeon has their own approach to educating patients about the risks of surgery. In our office we approach this through more than one office visit, written and verbal discussions and selective access to information on patient edcuational areas of our website. Be an informed patient by asking the questions you need answers to, before having surgery. Good luck!