Problems after umbilical hernia surgery
August 5, 2011 | 15,00 EUR | answered by Dr. med. Ralf Berg
Hello dear medical team,
I underwent surgery on May 23rd. It was not necessarily necessary, as I had no symptoms, no obstructions, etc. It was about millimeter-sized 'holes'. A ventral hernia and an umbilical hernia. I even suggested the removal of the umbilical hernia myself because I thought it would give me a nicer abdomen. The surgeon agreed and mentioned that there would be a scar from the belly button upwards 5cm vertically.
The appearance of the scar doesn't bother me as much. But since the surgery, I have had the following problems: I have lost weight, causing the skin around the scar to contract significantly and pulling the entire abdominal wall downwards. This results in very strong pressure and tension pains, especially when lying on my stomach. Also, the abdominal tension is not present, and I sometimes have a 'tremor breathing'. It feels as if there is now too little skin on the upper abdomen, where the scar is located, but suddenly much more skin and folds on the lower abdomen than ever before. I have gained and lost weight in the past, but never had any problems or complaints. My abdomen was always relatively high.
Where the umbilical hernia was stitched (simple suture technique) has been reported by a colleague surgeon, from whom I sought a second opinion, to have been stitched very tightly (it also feels like there is a thick button in the abdomen) and the inner scar is also stuck to the muscle fascia. He saw this on ultrasound. In the chaos, I forgot to ask him: could my problems be from this?
I have problems walking and climbing stairs: it hurts just below the abdomen where the buttocks begin, making it difficult to move my legs. Overall, it seems as if the abdomen/center of gravity has shifted downwards: before, I had a small high-standing belly, now I suddenly have a two-part abdomen, or a sagging belly with a thick fold directly under the navel, with further folds below, which are also red because they press. The skin on the upper abdomen is pulled downward by the scar. This folding also bothers me when sitting.
A suture granuloma was also found at the top of the scar, which is noticeable as a hard knot, and has already caused pain. According to the surgeon, this should be removed if it causes further problems.
The worst part for me is the loss of my general health and well-being. I had no problems before, as I said, they were millimeter-sized 'holes'. Now, I find it difficult to walk, climb stairs, hike, sit, and lie down. Could this be due to the umbilical hernia being stitched too tightly? And also, that the entire shape of the abdomen changes as a result?
If I pull the skin on the upper abdomen just half a centimeter upwards, everything feels better: breathing, abdominal tension. But a
Dear patient,
this is all not very nice for you, and the changes in skin folds and abdominal wall tension are indeed obvious. However, I would like to correct your idea of the shift in the center of gravity of the body. This cannot be changed by closing two small abdominal wall hernias. What you are experiencing is a disorder of the abdominal wall and body tension.
So, what should be done: you have already discussed most of this with the surgeons. Firstly, a procedure can be done to correct the scars. Granulomas will be removed and adhesions with the muscles will be loosened. This should alleviate the discomfort to some extent.
Secondly, a cosmetic procedure to tighten the abdominal skin could be considered, as the wrinkled relief is unlikely to change on its own even with a healed (re-stretched) scar. However, before choosing either option, you should definitely explore ALL possibilities of conservative therapy.
This means that every scar initially contracts and loosens over time (which can take up to 3/4-1 year, in your case until Dec 2011/March 2012). This stretching can be supported with physical therapy. Additionally, muscle-building training should take place, not only for the abdominal muscles but also for the back muscles. (This also takes 6-8 months to be effective). All of this should be covered by your health insurance upon request, as a consequence of the surgery. Although it may be tedious, it may help you regain proper fitness in your core and prevent future back issues.
The plastic surgeries, which you will have to pay for privately in any case, should, in my opinion, be done after this training. Whether the scar correction should also be postponed or needs to be addressed sooner, depends on how much these complaints affect the aforementioned mobilization.
PS: Regarding your radiating leg pain, you should at least have a clinical examination of the lumbar spine to rule out any disc problems!
Overall, I believe (with the limitation that I cannot examine you over the internet) that you will not have to live with these complaints in the long run. With some patience, effort, and possibly a scar correction, your complaints will improve. In my almost 20 years of practice, about 10 patients with umbilical or inguinal hernias have had similar issues. 1/3 improved with minimal physical therapy, another 1/3 improved after a longer period and intensive physical therapy, and 3-4 patients eventually had to undergo surgery again, but none of them have any complaints related to this issue now.
Hindsight is always 20/20, but address the problems, you are already on the right track. I strongly recommend finding a good physiotherapist and fitness trainer and starting the above measures.
Best wishes,
Dr. R. C. Berg
