I have a MASSIVE incisional hernia post an abdominal wall
reconstruction to attempt to repair an earlier MASSIVE incisional
hernia.  In all, to date I have had four abdominal surgeries,
beginning with a hemi-colectomy seven years ago.  What are the chances
for a laparoscopic repair?  If laparoscopic repair is possible, what
is normal post-op course?

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Request for Question Clarification by nenna-ga on 05 Jun 2005 12:37 PDT

Hi Candaceb-ga,

I am interested in answering your question, but I believe
that to answer it well, your question will require more time
and effort than the average amount of time and effort associated
with this price.  Here is a link to guidelines about pricing
your question, https://answers.google.com/answers/pricing.html

If you both raise your price and also post a clarification here,
the system will notify me and I will take another look at your
question. 

Nenna-GA
Google Answers Researcher

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Clarification of Question by candaceb-ga on 05 Jun 2005 22:48 PDT

My current situation is not so much a recurrent hernia as a failed
abdominal wall reconstruction.  The surgeons connected the mesh to
fascia, which I have been told (and told them) is paper-thin and
shreddable.  Sepra film mesh was used, secured with 0 Prolene suture. 
Defect at that time was approx. 10 x 14 cm.  At this time, my hernia
extends from hip bone to hip bone to approximately three inches above
where my umbilicus was, and intestines can be felt over my public
bone.  I am 54, 5'10", 165# In good health excepting typeII diabetes
which is well under control (fasting glucose readings in very low
80's) and chronic asthma which is well managed with medication and
thrice daily nebulizer treatments.

You should give some more details. Have you had mesh used (note the
sponsored link at the end of your question)? How old are you and what
is your general health condition otherwise? Have your surgeries been
done in the US? A perhaps delicate issue is how good your insurance
coverage is. I defer otherwise to Nenna.

I have added a clarification for nenna, which I think you should be
able to see.  If not, I'll repeat it here for you.  I have not so much
a recurrent hernia as a failed abdominal wall reconstruction.  A Sepra
film mesh was used to repair a defect of approx. 10x14cm and secured
with 0 Prolene stitch.  My current "hernia" extends from hip bone to
hip bone, from about 3/4" above where my umbilicus used to be and
there are intestines present over the public bone.  I am 54, 5'10",
165#
Yes, all surgeries were performed in US, and I have Aetna PPO, which
paid for the surgeons, and all hospital costs.  My general health is
good, although I have Type II diabetes (well under control - fasting
glucoses run 82/83) and chronic asthma which is managed with
medication and thrice daily nebulizer treatments.  If you require any
more information, please let me know.

Well, I wandered down, a scant 2 two-blocks away, to the local
emergency room complaining of the worst stomach-ache of my life. I had
not really eaten for two days, and had only drunk milk (and had done
Tums and Rolaids, as well as done an enema). It was Fathers' Day, a
Sunday, about 1999.

Doctor came in and I told him my symptoms (I have always worked in a
hospital and know stuff, without being a doctor). I suggested a small
bowel obstruction. The CT was very puffy. So they admitted me, and
after all family was informed, I barfed in the hospital room, in the
presence of my family. They moved me up the River to LaCrosse WI where
I was admitted to the service of Dr. Christopher Huiras (that's a
Baltic name). I adultly told him I agreed it was possible that I would
wake up with a stoma (a colostomy), and then agreed to the surgery.

Well, Dr Huiras said it was Crohn's disease while Dr Cramer says it's
irritable bowel syndrome (I agree with the latter). I grossed out the
nurses by looking at the Polaroids of my guts being displayed on my
abdominal surface and seeing how beautifully Dr. Huiras did his
surgery; in other words, I really did look at my chart.

There were complications to my surgery. My surgical wound dehisced. I
felt the warm liquid stuff falling onto my hands as my abdomen
drained, and obviously, got re-operated. So I ended up with plastic
things holding my belly together. I was three weeks at
Franciscan-Skemp in LaCrosse.

Hi,

My expertise doesn't extend quite as far as abdominal laparoscopic
surgery, but I can tell you with some certainty that laparoscopic
repair of an INCISIONAL hernia is most likely not possible. A massive
hernia as you described (exacerbated by symptomatic recurrence I
presume) is too delicate to repair using this type of surgery. Apart
from the fact that a massive hernia is just too large and "fiddly"
using keyhole techniques. Laparoscopes can aid in the prognosis of the
wounds, but they need to open you up for a proper repair. I assume the
hernia was a result of the colostomy, or in addition to?

In any case, the most safest and useful applications for laparoscopic
surgery in herniation is (99% of the time) only in inguinal and
femoral hernias.

HI Candaceb,
Just last week I heard from a friend that his wife seems to have had a
very similar operation, the mesh and all.  Post-operation:  she wears
a support girdle is not allowed to pick up/carry anything over 9 lbs
in weight.

Take care, Myoarin