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Will a tummy tuck using redundant tissue fix a large incisional hernia?

Q:

I had weight loss surgery (VSG) about 2 years ago and developed a large incisional hernia. My bariatric surgeon said he can fix it without mesh using a tummy tuck and said something about using the redundant tissue developed from the weight loss. I've been trying to find information on this surgery and recurrent rates but can't seem to find anything. If anyone knows this information I'd appreciate it. Thanks!

A:

 What your Bariatric Surgeon appears to be describing is the utilization of autogenous human dermis to reinforce your hernia repair. The dermis is the skin layer below the epidermis which is the strong structural component of your skin.

 Most likely they are planing to remove some of the excessive skin, harvest the dermis and use it as an assistance in your hernia repair. Sometimes artifical dermis is utilized in these types of hernia repairs. These types of procedures are usually not considered as Tummy Tucks. 

 Consider returning to your surgeon and ask them to address your concerns. Then, consider a consult with a member of the ASAPS in your area for a second option. Often Aesthetic Surgeons repair hernias as part of a Cosmetic Tummy Tuck. Here is a link to some patients  ( http://garyculbertson.com/body-plastic-surgery-before-and-after/ ). Lipo-Abdominoplasty # 12 had failed an attempted endoscopic hernia repair and  Lipo-Abdominoplasty # 6 is a massive weight loss patient where we found/ repaired a groin hernia at the time of her Tummy Tuck. Hope this is of assistance. Best,

 

Gary R Culbertson, MD, FACS

A:

There are multiple ways to repair incisional hernias during tummy tucks. You have significant excess muscle fascia (the heavy tissue encasing the muscles) because of your weight loss. With an abdominoplasty, this is totally exposed. This can be imbricated and reinforced to repair the hernia. If it appears that you need extra reinforcement, then you could use an artificial mesh, an acellular dermal matrix or a piece of your own dermis taken from the skin that will be discarded. All of these things work well. The problem lies in where your incision is. Some are easier to repair than others and some create significant problems in blood supply to the tissue beyond the incision that can reduce the ability for the tummy tuck incision to heal. Therefore, make sure that whomever does your tummy tuck has significant experience in abdominoplasty. This is where the experience needs to be. Any good plastic surgeon can also repair the hernia.

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