I had a kidney transplant almost 7 years ago. I developed a bulge on right side. Would a tummy tuck help?

Question

had hernia surgery was told it was adhesions.Since surgery it has grown much larger. It is painful and I am having diarrhea often. My stomach area is extended. Had a CT and everything came back normal. Would a tummy tuck help these problems?

Vishnu Rumalla, MD · Answer

Thanks for an excellent question.  First, you need to be seeing your nephrologist and doctors to understand your GI symptoms.  After this, it is important that wound healing from any surgery can be delayed or affected by your immunosuppressive drugs. Without a picture it is hard to tell, but the bulge you refer to may be a true hernia or simply weakness in your muscle that does occur after transplantation. You should probably discuss with your transplant surgery who then may work with a plastic surgeon to help with overal contour.  Good Luck.

Kenneth Hughes, MD · Answer

It would be helpful to examine the CT scan itself as well as view pictures of you from multiple angles to make an assessment.Kenneth Hughes, MDLos Angeles, CA

Earl Stephenson, Jr., MD, DDS, MBA · Answer

It's hard to determine what you would need without a picture. The picture be helpful since everything on your CT came back normal. On a broader note, your are a transplant patient which you receive immunosuppressive drugs. These drugs are rarely altered and have many drug interactions. You may not be a candidate for cosmetic surgery regardless.Earl Stephenson Jr MD DDS FACS

David Shifrin, MD · Answer

I performed a tummy tuck on a patient with a similar history. She had given a kidney and had an old scar over her flank and a large bulge under the scar. I tightened the fascia over the bulge. The bulge was improved but not totally fixed. The issue is the muscles were cut during the kidney surgery and lost the normal tone. It can be improved, but not 100% fixed. The other consideration is the location of the kidney scar. If it's high on your side (flank) and cannot be included in the skin resection, the skin below it is at risk to die and leave an wound that takes time to heal.

Lisa Cassileth, MD, FACS · Answer

Bulge after kidney transplant, also seen relatively commonly after spinal surgery, is often an area of the abdominal wall that is not innervated, from the prior surgery. That area bulges out, rather than flexes, whenever you use your abdominal muscles,  and therefore over time stretches. This can be unsightly and painful, and CT scan is usually normal as it not a true hernia (hole in the abdominal wall). A mesh needs to be placed that bridges the remaining healthy areas, usually from further back from the incision (under the external oblique), all the way to the other side of the abdomen (I attach within the contra lateral rectus sheath). Make sure your surgeon is very familiar with the problem- many patients tell me other doctors told them "nothing was wrong" even though the problem is usually pretty obvious!

Jeffrey Zwiren, MD · Answer

This can be a difficult problem.  First clear surgery with your transplant surgeon to be sure you are a candidate for an elective procedure.  If cleared then you would need to be examined by an experienced plastic surgeon to determine which type of abdominal wall repair would be indicated.

Robert T. Buchanan, MD (retired) · Answer

An abdominal
bulge after kidney transplant surgery is classified as a pseudohernia.Since it is not a true hernia, it will not
show up on a CT or MRI.It generally
represents a general weakness of the muscles.However, with GI symptoms, you could have more going on.Without more information and a direct
examination, it is impossible to tell you what probably is what needs to be
done.It would, however, the unusual
that a Tummy Tuck would solve your problem, even with modifications and
application of mesh to the abdominal muscles.I would suggest that you see the surgeon who did the transplant or a
very experienced transplant surgeon for further evaluation.

Maan Kattash, MD, FRCS, FACS - Account Suspended · Answer

You may have a recurrence of your hernia. This can create future functional concerns and should be a priority. I recommend having it checked out first by your general surgeon. Once dealt with, the skin overhang can be evaluated by a plastic surgeon as a secondary issue. Good luck.

Daniel Greenwald, MD (in memoriam) · Answer

This is a common problem and is most likely related to what is called an "adynamic" muscle segment, a place where the is not a frank hernia but the muscle has no strength and thus bulges.  Repair is easy, but long term results are variable because the muscle continues to stretch.  Best results require a patch, usually mesh or biologic membrane, that can bridge the weak part.

I had a kidney transplant almost 7 years ago. I developed a bulge on right side. Would a tummy tuck help?

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