Abdominal hernia are small (or large) openings in the abdominal wall (the tough tissue that encloses your abdominal cavity (stomach, colon, small intestine etc). Normally the abdominal wall is complete, ie there are no openings in it. When a hernia is present, an opening/hole in the abdominal wall allows some the abdominal contents to come out through this hole. Small hernias often go undiagnosed and are completely harmless. In large abdominal hernias your bowel can ’spill out’ of the abdomen and then it looks like you have a bulge on your abdomen. When you cough or strain, this bulge becomes bigger. Aside from looking strange, these hernia can be dangerous in that the bowel that has spilled out of the abdominal cavity can become obstructed and require surgery.

Small, undiagnosed hernias are generally completely harmless. However, in Plastic Surgery they can represent a hidden trap. Yesterday while performing a tummy tuck, I came across a small hernia right next to the belly button. It was less than a centimeter in diameter, and became visible only when I pulled on the abdominal wall. For the purpose of this tummy tuck, this hernia was completely harmless. I used a permanent suture to close the opening and moved on with my procedure. HOWEVER, if this patient was having a liposuction procedure done, I can only imagine with horror how a liposuction cannula could enter the abdominal cavity through this opening and cause a bowel injury. So now the question is, how do you avoid this potentially devastating complication? I have though a lot about this problem. I reviewed the literature on bowel perforations and liposuction. This is a rare complications and most published articles talk about case reports. One paper suggested performing this procedure under local anesthesia so that if there is any intra-abdominal injury, the patient would feel pain right away and then the injury could be treated right away instead of waiting until the patient get sick. None of the articles have investigated how the actual injury has happened. It is my theory at this time that if a bowel perforation ever happens, it is most likely through a pre-existing hole in the abdominal wall. I find it difficult to believe that a blunt tip liposuction cannula could rip through the rough abdominal fascia unless a large amount of force is used and the cannula is directed straight into the fascia.

Martin Jugenburg,MD, FRCSC
Toronto, ON

Having recently had a surgical complication, I was reminded of the importance of discussing surgical risks and complications with patients. I review risks and complications with patients every time we meet (initial consultation and pre-surgery review), describing possible and less likely potential complications. Unfortunately, recently one of my patients had one of those rare complications.

Having my patient go through a difficult recovery period has been tough. As I’ve never had to face such a situation, and I was very upset about what happened. My colleagues have reminded me that every one has his or her own nightmare story about the time when a procedure did not go according to the plan. Knowing that others have had this same rare complication as well and that they and their patients recovered well is somewhat comforting. Yet, I will not be able to rest until I determine exactly what went wrong so that I can prevent this complication from happening again. I have stopped performing this particular procedure until I get some kind of an answer as to what exactly went wrong. I think it’s the right thing to do.

Surgical complications are a part of any surgeon’s practice. The simple fact is that no surgical procedure is fool proof, and no surgeon is perfect. For this reason it is important that every patient fully understands the potential risks and complications before agreeing to undergo any surgical procedures. Most often things go well and if a complication does occur, it is usually a minor complication that resolves over time. In rare instances these complications can be severe or even life threatening. In Plastic Surgery, we are lucky in that our procedures rarely cause severe injury or death. In other specialties, such as general surgery or neurosurgery, for example, a complication can rapidly snowball into a life-threatening situations.

If you are a patient wanting to learn more about potential complications, please read Dr. Jugenburg’s information page about surgical complications and their management

Martin Jugenburg,MD, FRCSC
Toronto, ON

Bariatric surgery (weight loss surgery) such as Lap-Band technique leads to significant weight loss and improvement in overall health and quality of life. Large weight loss, however, leaves behind significant amount of excess skin which may not shrink with time. For patients whose excess skin has not gone away, we offer Body Sculpting plastic surgery procedures. This is a group of procedures designed to removed the excess skin and to sculp the remaining body into a more natural and youthful shape.
Excess skin on the back leads to skin folds, especially around the bra in women, which can be difficult to treat with standard techniques. A recently described Bra-Line Back lift offers an answer to all those people who have been troubled by this problem. In this surgical procedure, excess skin and skin folds on the back are removed, and the resulting scar is designed to be hidden by the woman’s bra. Results of this surgery can have a stunning effect on the shape and youthfulness of one’s back. At The Plastic Surgery Clinic Dr. Lista and Dr. Jugenburg work together to provide you with the benefit of two skilled and experienced surgeons, aiming for a better, safer result with a quicker recovery.

Martin Jugenburg,MD, FRCSC
(www.plastica.ca)
Toronto, ON