Assist. Prof. Boštjan Mlakar, M.D., Ph.D.
Private clinic ZDRAV SPLET, Maribor, Slovenia
bostjan.mlakar(at)zdravsvet.si

 

Introduction: Abdominoplasty is a common aesthetic procedure with higher rate of complications compared to other aesthetic operations. There is no consent if we should perform hernioplasty simultaneously with abdominoplasty or is it better to perform hernioplasty first to avoid additional potential complications.
Methods: We analysed complications after lipoabdominoplasty with or without hernioplasty at our institution in the period from 2010 to 2014. Minimum follow-up period was 16 months.
Results: All 26  lipoabdominoplasties were performed under local tumescent anaesthesia with i.v. sedation and discharged home 2 to 3 hours after the operation. Simultaneous hernioplasty was performed only in cases when small umbilical or incisional hernia can be easily repositioned with few fingers during the period of liposuction. In 14 cases we performed lipoabdominoplasty, in 4 cases we performed minimal lipoabdominoplasty without repositioning of umbilicus. In 7 cases simultaneous abdominoplasty and hernioplasty of umbilical or incisional hernia were performed if the defect in the abdominal wall was not bigger than 2 x 1,5 cm. In such cases we performed hernioplasty with non-resorbable stitches. In one case we performed a two stage procedure. Incisional hernia wall defect in this case was 4 x 2 cm and protruding hernia sac was a fist-sized.
Minor sufusions were present in 19/26 cases. There were no such haematomas or seromas that needed any intervention. Minor wound dehiscence (less than 5 cm) occurred in 3 cases. None of them had simultaneous hernioplasty. We had one huge wound dehiscence with wound infection which we solved using the VAC system. There were no cardiopulmonary complications and no hernia recurrence. A scar correction was needed in two cases.
Conclusions: Perforation of abdominal wall during liposuction can cause injury of intraabdominal organs and that risk is much higher in case of hernia, therefore is of paramount importance that we avoid one stage procedure when hernia wall defect cannot be easily secured with placed surgeon fingers during the liposuction. There is also an increased risk of umbilical necrosis in case of simultaneous umbilical hernia repair and abdominoplasty because umbilicus maintains its only blood supply from underlying fascial attachments via the umbilical stalk. To avoid that, we always leave intact the most of fascial attachments of the umbilicus stalk at its base. Patient safety and avoiding potential complications should always be the prime concern when deciding about one stage procedure (simultaneous hernioplasty and abdominioplasty).