Keep It Where It Belongs 

You’ve all read about my cancer dance in one blog or another. Thank goodness, that’s over. But there are residual effects like hand and foot neuropathy, chemo brain (akin to CKD’s brain fog), and – to my great surprise – abdominal incisional hernia after surgery. How did that happen, I wondered.

Get ready for this: those with Chronic Kidney Disease have a 12.8% higher incidence of abdominal incisional hernia according to a PubMed 2013 study published on ResearchGate’s site available at https://bit.ly/3kdvxfl,

“Chronic kidney disease is associated with impaired wound healing and constitutes an independent risk factor for incisional hernia development.”

(The percentage of abdominal incisional hernia among CKD patients was taken from the cohort in this abstract.)

According to the same study:

“Elevated uremia toxins may inhibit granulation tissue formation and impair wound healing, thereby promoting incisional hernia development.”

As Chronic Kidney Disease patients, we know the accumulation of uremia toxins as uremia. On to my favorite dictionary, the Merriam-Webster at https://www.merriam-webster.com/dictionary/uremia for a definition of uremia:

“1: accumulation in the blood of constituents normally eliminated in the urine that produces a severe toxic condition and usually occurs in severe kidney disease

2: the toxic bodily condition associated with uremia”

It gets worse. First, you have to know that I am considered ‘elderly,’ another surprise.  According to The World Health Organization at https://bit.ly/32sQq05:

“Most developed world countries have accepted the chronological age of 65 years as a definition of ‘elderly’ or older person….”

I’m 73 and here’s why you needed this information that I am of advancing age.

“The risk factors for incisional hernia following abdominal surgery include (ranked by relative risk):

Emergency surgery

Emergency surgery carries double the risk of elective surgery.

Wound type

BMI >25

Obese patients are more likely to develop an incisional hernia

Midline incision

There is a 74% risk increase compared to non-midline

Wound infection

This increases incisional hernia risk by 68%.

Pre-operative chemotherapy

Intra-operative blood transfusion

Advancing age

Pregnancy

Other less common risk factors include chronic cough, diabetes mellitus, steroid therapy, smoking, and connective tissue disease.”

Thank you TeachMeSurgery at https://bit.ly/2GYrOUH for this risk factor information.

I have so many risks factors. Foremost for me, of course, is Chronic Kidney Disease as demonstrated earlier in this blog, but also advancing age. Oh no, we’ll have to add obesity since my oncologist just told me my BMI is higher than 25 and must be lowered in order to keep the possibility of cancer reoccurrence to a minimum.  Then there’s midline incision. My scar runs down the middle of my front from the breasts to below the belly button. Oh, and let’s not forget pre-operative chemotherapy. I had plenty of that. Then there’s intra-operative blood transfusion… to the tune of six for me. I almost forgot to include diabetes mellitus. Hmm, I do believe I had steroid therapy during my chemotherapy treatments, too.

Now what? The hernia is right there, visibly noticeable along the scar line and I understand all the possible reasons it’s there. We all know I have to do something about it, but why? Healthline at https://www.healthline.com/health/hernia#complications answers that question for us.

“Sometimes an untreated hernia can lead to potentially serious complications. Your hernia may grow and cause more symptoms. It may also put too much pressure on nearby tissues, which can cause swelling and pain in the surrounding area.

A portion of your intestine could also become trapped in the abdominal wall. This is called incarceration. Incarceration can obstruct your bowel and cause severe pain, nausea, or constipation.

If the trapped section of your intestines doesn’t get enough blood flow, strangulation occurs. This can cause the intestinal tissue to become infected or die. A strangulated hernia is life-threatening and requires immediate medical care.”

Uh-oh. What can I do? My oncologist suggested a wait and see approach with a twist. I’m now wearing something similar to the belly band that pregnant women wear. The differences are that this is worn around my body to cover the hernia and is very tight in an attempt to have the hernia heal itself. Will this work? That remains to be seen.

What if it doesn’t? Well, there’s always surgery. The National Center for Biotechnology Information (NCBI) at https://bit.ly/3hsFHae tells us,

“The treatment options for incisional hernias are open surgery or minimally invasive surgery. Minimally invasive surgery is also called ‘keyhole surgery,’ or ‘laparoscopic’ surgery if it is performed on the abdomen.”

Wait a minute, laparoscopic surgery. What’s that? Let’s go to MedlinePlus to see what we can find out. This explanation was at https://bit.ly/2RmkS5R.

“Laparoscopic surgery is a surgical technique in which short, narrow tubes (trochars) are inserted into the abdomen through small (less than one centimeter) incisions. Through these trochars, long, narrow instruments are inserted. The surgeon uses these instruments to manipulate, cut, and sew tissue.”

That does seem less invasive, but it’s still surgery. Let’s take a look at recovery time for laparoscopic surgery vs. open surgery. Open surgery is just what it sounds like: you’re cut open.

“When the surgeons are equally skilled and a procedure is available as both an open procedure and a minimally invasive one, the minimally invasive technique almost always offers a lower risk of infection, shorter recovery times and equally successful outcomes.”

Mind you, sometimes keyhole or laparoscopic surgery is not a choice since the surgeon needs to work on a larger area. For example, I had open cancer surgery since not only the tumor, but also my gall bladder and spleen, needed to be removed. Sometimes, what starts out as minimally invasive surgery becomes open surgery when the surgeons run into a problem or realize they need to work on a larger internal area than they’d originally thought.

I still find it amazing how connected all parts of our body are… like Chronic Kidney Disease adding to affecting a scar to the point that a hernia develops.

Until next week,

Keep living your life!