As with any medical procedure, the question of cost is usually high on the list of concerns. Does insurance cover this? Well, the good news is when it comes to an Umbilical Hernia Repair, insurance will usually deem this a medically necessary procedure. If performed in conjunction with a Tummy Tuck, that portion will have to be paid for out of pocket, since it is considered an aesthetic or cosmetic procedure. While a Tummy Tuck aims to remove excess skin and reattach the abdominal muscles to the abdominal wall, a hernia repair often involves the first half of a Tummy Tuck procedure where the muscles are pulled together, which it is commonly performed with a Tummy Tuck.
Sometimes you may need to find a general surgeon as well as a plastic surgeon to perform both procedures at once. It is also very important that you submit exactly what is being done to your insurance company to be sure of what they will and will not cover beforehand. Sometimes your surgeon may not advise you to receive both procedures at the same time. There is a greater risk for impaired blood supply to the umbilical stalk or the hernia may not be in the best place to also perform an abdominoplasty. As with any surgical procedure, it is important that you know the costs and what is and isn’t covered by your insurance provider. Dr. Hovsepian will do his best to help you along this process. He will also be sure to go over any possible risks and side effects of the procedure to make sure you are confident and comfortable with your decision to undergo plastic surgery.
Tummy Tuck After Umbilical Hernia Repair with Mesh
While a Tummy Tuck aims to remove excess skin and reattach the abdominal muscles to the abdominal wall, a hernia repair often involves the first half of a Tummy Tuck procedure where the muscles are pulled together, which it is commonly performed with a Tummy Tuck.
Sometimes you may need to find a general surgeon as well as a plastic surgeon to perform both procedures at once. It is also very important that you submit exactly what is being done to your insurance company to be sure of what they will and will not cover beforehand.
Sometimes your surgeon may not advise you to receive both procedures at the same time. There is a greater risk for impaired blood supply to the umbilical stalk or the hernia may not be in the best place to also perform an abdominoplasty.
It’s crucial that you are aware of the costs and what your insurance company will and won’t cover before undergoing any surgical procedure. Dr. Hovsepian will do his best to help you along this process. He will also be sure to go over any possible risks and side effects of the procedure to make sure you are confident and comfortable with your decision to undergo plastic surgery.
Umbilical Hernia Repair with Mini Tummy Tuck
Abdominal wall hernias are often diagnosed on clinical examination or encountered intraoperatively during an abdominoplasty. When traditional surgical techniques for abdominoplasty and umbilical hernia repair are used together, they might make it harder for blood to get to the umbilicus. The authors describe a simplified surgical technique for the correction of umbilical hernias in conjunction with abdominoplasty. This procedure avoids any fascial incisions immediately adjacent to the umbilicus, thereby maintaining a maximal blood supply to the umbilical stalk. Over a six-year period, 17 patients underwent the described procedure. None have had a recurrence of their hernia or umbilical necrosis, and the aesthetics of the umbilicus have been improved.
Abdominoplasty is one of the most common aesthetic procedures performed in the United States. One of the primary indications for the procedure is skin and fascial laxity, which is often found in multiparous women.1–5 A frequently-encountered problem associated with the occurrence of fascial laxity or diastasis is abdominal wall hernias. In fact, hernias are often diagnosed on clinical examination or are encountered intraoperatively during an abdominoplasty. One of the most common locations for a hernia to occur is in the umbilical and periumbilical area. Locating an umbilical or periumbilical hernia during an abdominoplasty gives the plastic surgeon a chance to fix the fascial defect surgically, which often makes a big difference in how the front of the abdomen looks overall. However, undertaking such a repair is not without potential consequences.
Traditional surgical techniques for performing an abdominoplasty include skin incisions circumferentially around the umbilicus, resulting in complete detachment of the umbilicus from the anterior abdominal flap. As a result, the umbilicus maintains its only blood supply from the underlying fascial attachments via the umbilical stalk. Standard repair of umbilical hernias involves fascial incisions immediately adjacent to the abdominal wall defect and extensive dissection in preparation for repair. Because of this deep cut, the umbilicus gets most of its blood supply from the attached skin around it through the subdermal plexus.
When the above-mentioned traditional techniques are used for both abdominoplasty and umbilical hernia repair at the same time, they may cut off the umbilicus’s blood supply, which can lead to tissue necrosis. 3–8 This increased risk has lead many surgeons to either avoid repair of these hernias or perform a two-stage procedure for correction. We describe an easier way to do surgery that does not involve making any cuts in the fascia right next to the umbilicus. This keeps the umbilical stalk getting plenty of blood and lowers the risk of umbilical necrosis.
Surgical Technique
The abdominal flap was elevated and the umbilicus was dissected from the anterior abdominal wall flap while leaving intact the fascial attachments of the umbilical stalk at its base. The abdominal flap was raised at the level of the anterior sheath to the xyphoid centrally and the costal margins laterally. The fascial plication was marked based on the degree of anterior fascial laxity. A 3- to 4-cm midline longitudinal laparotomy incision was then made through the linea alba, beginning 2 cm inferior to the umbilical stalk. The fascial defect was identified and the hernia reduced from the undersurface of the umbilicus either in the pre- or intraperitoneal space. The hernia was then repaired with interrupted, nonabsorbable monofilament sutures (Figure 1, A-D). The midline laparotomy fascial incision was then closed with running monofilament suture. Plication of the rectus fascia was then performed using the previous markings, which allowed for symmetrical placation of the anterior sheath. Excess abdominal skin was excised in the normal fashion and the umbilicus delivered through a midline incision. In most cases, it is secured to the underlying fascia at the three, six, and nine o’clock positions.
A, Umbilical hernia. B, Midline infraumbilical incision through the linea alba. C, Marking of the umbilical hernia. D, Repair of umbilical hernia with interrupted monofilament suture.
Tummy Tuck with Hernia Repair Photos
tummy tuck with hernia repair cost
Many of us know all about the benefits of tummy tuck surgery. Also known as an abdominoplasty, a tummy tuck is a surgical procedure that tightens your stomach muscles. It removes excess skin and creases on your abdomen, which are the result of rapid weight loss, pregnancy, or aging.
It is a hugely popular cosmetic procedure with the numbers to prove it. According to the American Society of Plastic Surgeons, the number of tummy tuck surgeries increased by 87% between 2000 and 2014.
As much as an abdominoplasty can improve your physique, many have begun to turn to this cosmetic surgery procedure to correct physical complications such as hernias.
What is a Hernia?
A hernia occurs when a stomach organ pushes through an opening in the muscle or tissue holding it in place. This usually happens when muscles in the stomach have weakened, often appearing in and around the belly button (navel).
When left untreated, it can lead to significant discomfort. Made worse by everyday actions such as sneezing, coughing, urinating or lifting heavy objects. More critically, this can even lead to severe damage, and perhaps the death of affected tissue.
Based on data from a 2015 study published in the The Journal of the American Medical Association, there were approximately 2.3 million in-patient abdominal hernia repairs between 2001 and 2010, roughly 567,000 of which were emergencies. Furthermore, such emergent hernia rates were most prevalent among adults 65 years and older.
Can a Tummy Tuck Cause a Hernia?
In short, there’s a chance that a tummy tuck causes a hernia. Developing a hernia is one of the usual risks, albeit an uncommon one, associated with undergoing an abdominoplasty. And because of this, many are left with the perception that the procedure causes hernias to develop.
Common hernias such as incisional hernias are located in the abdomen and can develop during or after an abdominoplasty. For instance, the sutures used to tighten the stomach muscles may accidentally damage the surrounding muscles. Conversely, it’s also possible it was already present before the tummy tuck procedure. It only became prevalent after removing the excess skin and fat surrounding it.
If you detect an abdominal bulge after undergoing a tummy tuck, be sure to inform your plastic surgeon. Your surgeon may ask you to get an MRI or CT scan to determine its cause.
Can You Perform A Tummy Tuck With Hernia Repair?
The short answer is yes. A tummy tuck can be performed with hernia repair. So, much like strengthening and tightening your stomach, a tummy tuck can similarly correct an umbilical hernia or ventral hernia.
The upper and lower abdomens are tightened during surgery. An incision is made around the belly button and extends to both sides of the hip, beneath the panty line.
Once the skin and tissue are lifted, your surgeon performs the hernia repair. They will push the protruding organ back behind the abdominal wall. The abdominal muscles are tightened and excess tissue is removed.
Final results can address weakened abdominal muscles and reduce pressure and discomfort on your skin.
The First Thing You Need To Do
Before undergoing a tummy tuck, be sure to consult first with your plastic surgeon to discuss how a hernia developed. Again, an MRI or CT scan can help pinpoint the cause.
You also need to look at the size of a hernia and whether your surgeon is comfortable treating it through abdominoplasty. If not, a general surgeon can perform the repair during the tummy tuck procedure. Either way, acquiring the insights and guidance from a specialist will go a long way in treating your condition. Under their care, you will learn about the right preparations, while understanding the risks you may encounter along the way.
umbilical hernia surgery
Umbilical hernia is a rather common surgical problem. Elective repair after diagnosis is advised. Suture repairs have high recurrence rates; therefore, mesh reinforcement is recommended. Mesh can be placed through either an open or laparoscopic approach with good clinical results. Standard polypropylene mesh is suitable for the open onlay technique; however, composite meshes are required for laparoscopic repairs. Large seromas and surgical site infection are rather common complications that may result in recurrence. Obesity, ascites, and excessive weight gain following repair are obviously potential risk factors. Moreover, smoking may create a risk for recurrence.
Umbilical hernia is a rather common surgical problem. Approximately 10% of all primary hernias comprise umbilical and epigastric hernias (1). Approximately 175,000 umbilical hernia repairs are annually performed in the US (2). It has been reported that the share of umbilical and paraumbilical hernia repairs among all repairs for abdominal wall hernias increased from 5% to 14% in UK in the last 25 years (3). A similar rise has been reported in a recent multicenter study from Turkey (4).
In general, umbilical hernias are more common in women than men; however, there are series in which male patients are more frequent (5). Typically, a lump is observed around the umbilicus. Pain is the most common indication to visit a physician and undergo a repair (6). Recurrence may develop even in cases where a prosthetic mesh is used. Recurrent umbilical hernias often tend to enlarge faster than primary ones and may behave as incisional hernias.
An umbilical hernia has a tendency to be associated with high morbidity and mortality in comparison with inguinal hernia because of the higher risk of incarceration and strangulation that require an emergency repair. Although the number of articles with the title word “umbilical hernia” increased 2.6-fold between the periods 1991–2000 and 2001–2010, there still appears to be a certain discrepancy between its importance and the attention it has received in the literature (7). In this paper, the nature of the umbilical hernias is reviewed, and the current options for their surgical repair are discussed.
Anatomic Description
Many umbilical hernias happen above or below the umbilicus through a weak spot at the linea alba, not directly through the umbilicus itself. These hernias have the same natural course and are treated the same way. The European Hernia Society classification (8) for primary abdominal wall hernias defines the midline hernias from 3 cm above to 3 cm below the umbilicus as umbilical hernia (Figure 1).
Abdominal wall hernias from 3 cm above to 3 cm below the umbilicus are defined as umbilical hernia according to the European Hernia Society Classification (8)
The borders of the umbilical canal are the umbilical fascia posteriorly, the linea alba anteriorly and medial edges of the two rectus sheaths on two sides. Herniation happens due to increasing intra-abdominal pressure. Predisposing factors include obesity, multiple pregnancies, ascites, and abdominal tumors (9). The content of the hernia sac may be preperitoneal fat tissue, omentum, and small intestine in the majority; a combination of those can take part. Large intestines are very rarely involved (10). The neck of the umbilical hernia is usually narrow compared with the size of the herniated mass, hence, strangulation is common. Therefore, an elective repair after diagnosis is advised.
Anesthesia
All three types of anesthesia (local, general, and spinal) are suitable in most cases. The patient and surgeon should make a decision regarding the type of anesthesia to be used before surgery. Local anesthesia often provides maximum comfort for patients when it is accurately performed in open repairs. Some centers routinely use local anesthesia (5, 11, 12). However, inexperience with the local anesthetic technique may cause discomfort to patients with an increased recurrence rate. Local anesthesia may also be challenging if the patient is obese and hernia is large and/or recurrent (13). In patients with ASA I or II scores and who have one of the specific difficulties above, the surgeon should better choose general anesthesia to feel more secure because the quality of repair is the most important outcome measure.
Laparoscopic ventral hernia repair generally requires general anesthesia with endotracheal intubation. Furthermore, it can be feasible under spinal anesthesia with low-pressure CO2 pneumoperitoneum (14).
Antibiotic Prophylaxis
Naturally, umbilicus is not a clean anatomical part of the body. The umbilical skin may not be cleaned of all bacteria even with the use of modern antiseptic solutions. Therefore, the surgical site infection can be more frequent following umbilical hernia repairs than that following inguinal hernia repairs. A 10% superficial wound infection rate is not surprising even after routine prophylactic antibiotic use. A recent study reported a 19% infection rate following open umbilical hernia repair (15). Kulacoglu et al. (5) reported 3% wound infection rate with antibiotic prophylaxis with cefazolin sodium that is administered 30 min before skin incision.
Deysine (14) recommended topical gentamicin in addition to preoperative intravenous prophylaxis to lower the infection rates after hernia repairs. He reported no surgical site infections in hernia surgery after setting this prophylaxis combination for 24 consecutive years. Although gentamicin is most effective against gram-negative bacteria, it is also effective against staphylococci. Furthermore, it has been stated that gentamicin can demonstrate antimicrobial synergy with cefazolin for a more successful antibacterial effect (16).
Which Repair Technique?
There are mainly two repair options for umbilical hernias: suture and mesh. Simple primary suture repair can be used for small defects (<2–3 cm). The technique of overlapping abdominal wall fascia in a “vest-over-pants” manner was described by William Mayo (17) and remained the most renowned surgical technique for a long time. There are few clinical studies with Mayo technique in the literature (6, 12). High recurrence rates up to 28% have been reported (10).
Prosthetic materials are widely used today in the repair of all kind of abdominal hernias. Arroyo et al’s (18) randomized clinical trial revealed that the recurrence rate was lower after mesh repair than that after suture repair (1% vs. 11%) in a 64-month mean postoperative follow-up. In a retrospective clinical series of 100 patients, the recurrence rates for the suture and mesh repair groups were 11.5 and 0%, respectively (p=0.007), with similar results in the infection rates in favor of mesh repair (19). A systematic review and meta-analysis by Aslani and Brown (20) revealed that the use of mesh in umbilical hernia repair results in decreased recurrence and similar wound complication rates compared with tissue repair for primary umbilical hernias. However, many surgeons still make his/her decision on the basis of the size of the umbilical/paraumbilical defect. Dalenbäck (21) suggested a tailored repair and stated that suture-based methods for defects <2 cm can provide acceptable recurrence rates (6%) in long-term follow-up. A postal questionnaire study from Scotland revealed that surgeons preferred mesh repair for defects >5 cm, whereas similar preference rates for suture and mesh repairs were obtained for defects <2 cm (22).
Meshes can be placed via both the open and laparoscopic approaches. Surgeons in general prefer the most familiar technique or comply with the patients’ preferences. Open onlay mesh placement is the easiest technique; however, it requires subcutaneous dissection that may cause seroma or hematoma and eventually result in surgical site infection in some cases. Mesh can also be placed in a preperitoneal or sublay position (5, 11). This may require more surgical experience and skill but avoids extensive subcutaneous dissection and reduces seroma formation and possibly result in less recurrence. Onlay and sublay mesh placement can be done at the same time in complicated or recurrent cases to provide more reinforced repair. Some authors prefer leaving fascial margins without approximation; however, suture closure before onlay mesh or after preperitoneal mesh is recommended.
Furthermore, mesh plug repair was described for umbilical hernias. It can be performed with local anesthesia (23, 24). However, there is no controlled study to compare plug repair with other techniques. Besides plug repairs have the risk of migration and enterocutaneous fistula formation (25).
Laparoscopic umbilical hernia repair has been practiced since late 1990s (26, 27). Single-port repairs have also recently been reported (28). Laparoscopic technique is basically a mesh repair; however, laparoscopic primary suture repair without prosthetic material has also been experienced (29). In contrast, Banerjee et al. (30) compared the laparoscopic mesh placement without defect closure with laparoscopic suture and mesh in a clinical study and reported a slightly lower recurrence rate in the latter group, particularly for recurrent hernias.
Today the utilization of laparoscopy for umbilical hernia repair remains relatively low in the world. Laparoscopy is preferred in just a quarter of the cases (31). There are a few studies comparing open and laparoscopic repairs for umbilical hernias. Short-term outcomes from the American College of Surgeons National Surgery Quality Improvement Program recently revealed a potential decrease in the total and wound morbidity associated with laparoscopic repair for elective primary umbilical hernia repairs at the expense of longer operative time and length of hospital stay and increased respiratory and cardiac complications (32). In their multivariate model, after controlling for body mass index, gender, the American Society of Anesthesiologists class, and chronic obstructive pulmonary disease, the odds ratio for overall complications favored laparoscopic repair (OR=0.60; p=0.01). This difference was primarily driven by the reduced wound complication rate in laparoscopy group.
The Danish Hernia Database did not reveal significant differences in surgical or medical complication rates and in risk factors for a 30-day readmission between open and laparoscopic repairs (33). After open repair, independent risk factors for readmission were hernia defects >2 cm and tacked mesh fixation. After laparoscopic repair, female gender was the only independent risk factor for readmission.
Obese patients with umbilical hernia comprise a special group. A recent comparative study by Colon et al. (34) stated that laparoscopic umbilical hernia repair should be the preferred approach in obese patients. They found a significant increase in wound infection rate in the open mesh repair group when compared with the laparoscopic procedure (26% vs. 4%; p<0.05). They observed no hernia recurrence in the laparoscopic group, whereas the open group had 4% recurrence rate. In contrast, Kulacoglu et al. (5) demonstrated that obese patients also require more local anesthetic dose in open mesh repair.
mini tummy tuck and hernia repair
Many of us know all about the benefits of tummy tuck surgery. Also known as an abdominoplasty, a tummy tuck is a surgical procedure that tightens your stomach muscles. It removes excess skin and creases on your abdomen, which are the result of rapid weight loss, pregnancy, or aging.
It is a hugely popular cosmetic procedure with the numbers to prove it. According to the American Society of Plastic Surgeons, the number of tummy tuck surgeries increased by 87% between 2000 and 2014.
As much as an abdominoplasty can improve your physique, many have begun to turn to this cosmetic surgery procedure to correct physical complications such as hernias.
What is a Hernia?
A hernia occurs when a stomach organ pushes through an opening in the muscle or tissue holding it in place. This usually happens when muscles in the stomach have weakened, often appearing in and around the belly button (navel).
When left untreated, it can lead to significant discomfort. Made worse by everyday actions such as sneezing, coughing, urinating or lifting heavy objects. More critically, this can even lead to severe damage, and perhaps the death of affected tissue.
Based on data from a 2015 study published in the The Journal of the American Medical Association, there were approximately 2.3 million in-patient abdominal hernia repairs between 2001 and 2010, roughly 567,000 of which were emergencies. Furthermore, such emergent hernia rates were most prevalent among adults 65 years and older.
Can a Tummy Tuck Cause a Hernia?
In short, there’s a chance that a tummy tuck causes a hernia. Developing a hernia is one of the usual risks, albeit an uncommon one, associated with undergoing an abdominoplasty. And because of this, many are left with the perception that the procedure causes hernias to develop.
Common hernias such as incisional hernias are located in the abdomen and can develop during or after an abdominoplasty. For instance, the sutures used to tighten the stomach muscles may accidentally damage the surrounding muscles. Conversely, it’s also possible it was already present before the tummy tuck procedure. It only became prevalent after removing the excess skin and fat surrounding it.
If you detect an abdominal bulge after undergoing a tummy tuck, be sure to inform your plastic surgeon. Your surgeon may ask you to get an MRI or CT scan to determine its cause.
Can You Perform A Tummy Tuck With Hernia Repair?
The short answer is yes. A tummy tuck can be performed with hernia repair. So, much like strengthening and tightening your stomach, a tummy tuck can similarly correct an umbilical hernia or ventral hernia.
The upper and lower abdomens are tightened during surgery. An incision is made around the belly button and extends to both sides of the hip, beneath the panty line.
Once the skin and tissue are lifted, your surgeon performs the hernia repair. They will push the protruding organ back behind the abdominal wall. The abdominal muscles are tightened and excess tissue is removed.
Final results can address weakened abdominal muscles and reduce pressure and discomfort on your skin.
The First Thing You Need To Do
Before undergoing a tummy tuck, be sure to consult first with your plastic surgeon to discuss how a hernia developed. Again, an MRI or CT scan can help pinpoint the cause.
You also need to look at the size of a hernia and whether your surgeon is comfortable treating it through abdominoplasty. If not, a general surgeon can perform the repair during the tummy tuck procedure. Either way, acquiring the insights and guidance from a specialist will go a long way in treating your condition. Under their care, you will learn about the right preparations, while understanding the risks you may encounter along the way.