Want TT, Had Umbilical Hernia Repair, then Had Twins. Surgeon Worried About Bowel Attachment?

Had a single, had a hernia repair with mesh, had twins. now i want TT but my surgeon is worried about bowel attachment to mesh. Had CT scan, and "hardness" could be either mesh folding or bowel attachment. Already necrosis of the skin underneath. I've had no symptoms that bowel is obstructed or perforated or anything. Can i still have a TT? Is my doctor just being overly conservative? Help please!

Doctor Answers 2

Hernia repair with possiable trapped bowel. / Reparacion de hernia con posible bloqueo del intestino

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This is a potential BIG issue that you might have.  The reason is that mesh can attach to bowel and be very difficult to remove. Also the bowel can get attached to tissue near the  hernia.  Both can be sometimes very problematic to reduce. If you have true "necrosis" of the skin then this is a urgent/emergent problem! The "necrosis" would make doing a tummy tuck unwise in most cases to do at the same time.  This is a complex case, consider getting a second opinion asap.


Good luck, and thanks for the question.



Anire Okpaku MD


Esto puede ser un gran problema lo que usted tiene. La razon es que la malla puede pegarse al intestino y la remocion es algo muy dificil. Ademas el intestino tambien puede pegarse a los tejidos que estan cerca de la hernia. Ambos pueden ser algunas veces muy dificiles de reducir. Si usted verdaderamente tiene necrosis de la piel entonces esto es un problema muy urgente! Debido a la necrosis fuera poco prudente hacerse la abdominoplastia al mismo tiempo en la mayoria de los casos. Esto es un caso complejo el cual requeria una segunda opinion.


Suerte y gracias por la pregunta.



Anire Okpaku MD

Miami Plastic Surgeon

?Bowel attachment to mesh, can I get TT?

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If this was an umbilical hernia repair, the mesh would be quite small, limited to the area about the navel.  I don't know what you mean by necrosis of the skin--can you attach a photo or more description. 

The surgeon doing your TT would not enter the abdominal cavity, and would stay superficial to the mesh. There might be an issue when it comes to tightening the abdominal wall in the areas close to the navel, but not an absolute reason to turn you down for that procedure. 

If your surgeon is uncomfortable with the procedure, by all means seek another opinion. In preparation, you might want to discuss the CT findings with the surgeon who did your hernia repair.

Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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