Tag Archives: plastic surgery

Pyloric stenosis: long-term complications

Parents with a pyloric stenosis (“PS”) baby are always reassured by their paediatrician and surgeon, as they should be.  Although PS is usually a fatal condition, it can be brought under control with a small surgical procedure that is very safe, and although this operation sometimes leaves the baby with one or two immediate but treatable problems like reflux, there are no long-term effects.

Reassurances like this are the norm – but are they telling enough of the story?

“If only we had known…”

In fact, the “silent majority” of those who have had surgery for PS seem to have no or only minor complaints (usually a sensitive tummy).  However, PS and its operation are relatively common, between 1 and 5 in every 1,000 infants in most of the countries where this blog is read.  And so online there are countless complaints about significant challenges for babies, children and adults after this operation.

The “Categories” search box to the right of this page gives access to some of the data and stories I have found.

Here are two personal stories about how PS affected adult survivors.

Both are from women who shared their experience in 2013 on Real Self, a U.S. website that promotes cosmetic or reconstructive surgery after weight loss, malformation, accident or surgery.

The first story is from a woman who writes about two things with which she struggled: deep loathing and self-consciousness  about her scar, a common issue especially for many who had PS surgery before minimal access techniques became available after about 1990.

Hernias  were this woman’s second nightmare, most likely caused by the violent vomiting of PS, the surgery, a constitutionally weak abdominal wall, or all of these.

The good news is that after 60 years and many surgical repairs she is now very happy.  She posted her story on 1 April 2013 under the nom-de-plume Adreamcometrue.

Surgical scar after herniation or rupture (but not the writer's)

Surgical scar after herniation or rupture (but not the writer’s)

My tummy problems began when I was 22 days old, in 1950.  No that is not a misprint.  I was born two months premature.  At 20 days I began projectile vomiting.  After a couple of days a diagnosis was made: pyloric stenosis.  Surgery was performed.  That surgery left my midsection a mess.  As a child and teen I was cursed with a huge vertical scar surrounded by bulging flesh.  Nothing like being a teen and wearing a long line bra.  Body issues were definitely present.

My first reconstructive surgery to repair multiple hernias was in 1970.  There were other hernia surgeries in 1982, 2000, 2005, and 2007.  After the surgery in 2007 I was left with a huge bulge on the upper left quadrant of my ab region.  Three different docs told me I did not have another hernia.  Finally, as I was shopping for a gown for my daughter’s up-coming wedding,  I was becoming more and more discouraged.  Dresses in my usual size were not fitting.

In frustration, I went to Dr. Barach (a plastic surgeon).  He made an appointment with a[nother] surgeon.  They both felt I had another hernia.  So on March 22 the surgeon took care of a hernia and a wall tear next to it and Dr. B took care of the tummy tuck.  I am so thrilled.  The first time I saw my middle, 5 days post op, I cried.  I never thought my middle could look this way… I look great with my drains and swelling.

Based on the stories shared by others here, I can only imagine what I will look like 6 months from now.  I have been seen by my plastic surgeon two times since returning home and have another appointment this afternoon.  Keeping my fingers crossed that the drains will be removed.  Thank you to everyone who reports here.

This website has been very useful and comforting.  I am looking forward to returning to the gym and am continuing to eat healthy…. well… Easter doesn’t count… Does it?  Have a great day!

P.S… Insurance covered the hernia portion of surgery but not the plastic surgeon’s bill.  The use of the Operating Room was also pro-rated, and we had to pay $875 for that.

Some days later she continued –

I am now 13 days post-op.  On day 10 my drains were removed…

I hadn’t taken my own “before” pics.  I asked for a set, which they gave me.  Now I have to figure out how to scan them onto my computer so I can post them.  What a difference!  My pre-op size 6 jeans fit with no muffin top.  Yay!..

The plastic surgeon reminded me that my walking should not resemble exercise, when I complained that it took 15 minutes to walk about ¼ mile.  The plastic surgeon said I shouldn’t even consider using a treadmill for a 6 weeks.  I was in the gym 5 days a week prior to surgery.  Due to issues that make me easily develop hernias and tears, I can’t do CORE exercises.

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The second story is a powerful reminder of the real risk of complications long after PS surgery and also during and after any subsequent surgery.  These problems are often unexpected and possibly disastrous.  This woman prepared for cosmetic surgery full of both anticipation and fear.  She first posted on 1 Jan 2013 as “1hotway” and I have felt it helpful to add some comments.

First of all, I just want to thank all of you beautiful ladies for sharing your amazing stories.  This site has been a true godsend to me.  I am 38 years old with 3 beautiful boys … All of the damage to my tummy was done with my first born.  I was 20, so I never really got to enjoy my body.  I got terrible stretch marks, and needless to say a two piece was never worn again.  I have been at a pretty average weight my whole life. …

The writer's damage after carrying children and two surgeries

The writer’s damage after carrying children and two surgeries

When I was a baby I had a little stomach issue called Pyloric Stenosis.  It left about a 3″ scar on the upper right side of my abdomen.  I also had my gallbladder removed at the age of 21. [This quite often happens after the PS operation but the risk is it seems never mentioned. Ed.]  They unfortunately had to do the open surgery that left about a 7″ scar on my upper right abdomen.  Ugh!  Right?  I look like a road map!

I am sooooo ready for this. Thank goodness I have a wonderful hubby who loves me just the way I am.  One of the four plastic surgeons I saw for a consult said he didn’t think I was a good candidate for the TT [tummy tuck].  The other three said it would be fine.  Of course this makes me very nervous.  I don’t want to settle or compromise for my results.  It’s all or nothing…

A few days later she wrote –

I love looking at all of these amazing stories, but some of them aren’t so wonderful.  I guess it is good to read the good and the bad, but frankly it scares the heck out of me.  Necrosis???  [The death of tissue cut off from the blood supply by the old scar(s) and then plastic surgery. Ed.]  That is really scary stuff.  I have just read some terrifying reviews on that.  I can only PRAY that doesn’t happen to me.  One of the plastic surgeons I saw said that I am at a higher risk for this because of myprevious abdominal surgeries.  My plastic surgeon that is doing my TT isn’t concerned at all.  He is confident there shouldn’t be a problem since my surgeries were so long ago.  I am getting really nervous and excited.

2 February 2013

Paid in full. Got recliner. Pre-Op in a week. This girl is ready and nervous.

11 February 2013

Had my pre-op today.  BP was a little high.  Probably from reading & signing all of the consent forms.  Not exactly thrilled about reading all of the worst case scenarios.  Trying not to think about all the bad stuff that could happen is easier said than done right?  Any ways, got my prescriptions and doctor took my before pics.  I’m all set now.  Just have to wait for the big day…

18 Feb 2013

Well, I can’t believe it’s finally almost my turn.  I think I have everything all dialed in.  My husband is amazing.  He keeps telling me to just relax and breathe, he will take good care of me…  I wish I could just do that…

2 March 2013 – 6 days post-op

Started getting a strange pain in my right shoulder blade.  By day 7 it was traveling down the right side of my back.  It hurt to take a deep breath in.  I saw my plastic surgeon.  Had a drain removed and told him about the pain I was experiencing.  He assured me it was nothing.  4 hours later I drove myself to the ER because the pain was getting worse.  They ran labs, X-ray, and CT scan.  They confirmed Ihad a pulmonary embolism and admitted me to the hospital right away.  I now have been getting shots in my tummy to break up the clot.  I also have to be put on Coumadin for six months.  This has been the scariest thing in the world to me.  I should have never put myself at this kind of risk with 3 kids and a husband who need me.  I’m very lucky it was caught so early.  Many others aren’t so fortunate…

I’ve noticed that the risk is much greater than I thought.  This has been my biggest fear in getting this surgery.  I felt confident with all of the precautions that were taken during and after the surgery but clearly it wasn’t enough.  I tried to be mobile, I had a shot of heparin right before the surgery, they used the leg squeezers on me too.  Obviously it was just out of my control.  I will never have an elective surgery again.  The risk is just way to great…

4 April 2013

…I still won’t ever say it was worth it, considering all I have been through.  Just so happy to be alive and here with my amazing husband and beautiful boys.

12 Feb 2014

Hello, it has been almost a year since my TT.  I’m going to be honest. I probably wouldn’t go with Dr. H… if I could do it over again.  I think he is a little arrogant and I would definitely go with a doctor who takes every precaution they can.  I know that Pulmonary Embolisms are rare, but most people don’t live through them, so I would go with the safest route.  There really is no way of knowing if the clot came from my pelvis or one of my legs.  I tried to be mobile as often as I could, so just not sure.  I also have to say that I wasn’t impressed with how long it would take for the staff to respond to my messages…

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Ugly scarring, herniation, adhesions blocking the gall-bladder, necrosis and other problems related to the scar, fear of the list of hazards we have to acknowledge before submitting to surgery, complications from the surgery…

The stories of just these two women (and the previous posts in this series) make me think I’ll keep encouraging those who can to try, even press for the medical treatment option for their PS baby before they sign a consent to surgery.

Scar reduction surgery

Almost a year ago I posted about scar reduction after infant surgery.  I won’t repeat what I wrote then, so if you are really interested in this subject, please click on the link and read that introductory material first: this post adds to it.

Many young and middle aged people are considering having their less-than-attractive scar from infant surgery revised.  Many others who have had infant surgery don’t care about their scar and know little about what caused it, they may even flaunt it with smart humour and even cleverer legends, or they just want to “move on”.  Somebody whose first pyloric stenosis (PS) surgery failed to relieve the obstruction and thus lives with two scars (considerately placed at 90° from each other) wrote recently:

i never had a problem, in fact the reverse.  my scars have always been there so nothing to be ashamed about. some people have glasses, some are bald, that’s me as well, lots of people have far more difficult socially handicapping problems.  accept your scar as a badge of survival and move on. 

Blessed are the extroverts and those whose infant illness is past and forgotten and whose surgical scars are overlooked – neither of them affecting them in any way.

However, not everybody is in that blissful condition!  And these folk are simply too numerous, their emotions too complex and deep-seated, and their well-being is too compromised for them to be brushed off.

This blogsite and that of a fellow blogger are dedicated to giving information, advice, resources, and encouragement to these people, with the message:  “we are not freaks, we are not alone, and healing is quite possible”.

Many may not be able to afford the cost of scar revision, but it seems that in many countries with health insurance this kind of surgery can be covered.  It’s certainly worth asking around and trying.

Even then, scar revision is not for everybody.

  • Some, having experienced past surgery’s effects on them, will not want it again for a non-life-threatening matter.
  • Others have to be told that scar revision surgery would be inadvisable, for any of several technical / anatomical reasons.
  • For others again, there is little or nothing to be gained in cosmetic terms: a surgical scar can only be removed or improved by creating another scar.

Abdominal scars that have become sunken, indented or that sprawl over a large area can often be revised with the most benefit, and when this surgery is done on someone with loose or excess skin (after several pregnancies or weight reduction like gastric banding surgery), there is much skin and tissue that can be removed with great cosmetic benefits: many scars can be cut out, greatly reduced in size, and often even moved far enough downward to be hidden from public view.  Sunken scars can often be separated from underlying tissue and smoothed, and the abdomen can be made taut and more even.

It has been found that whilst most upper and lower midline scars often respond well to revision surgery, but those under the ribcage (from a sub-costal or Kocher’s incision which was often used in the past for PS and gallbladder surgery) can be difficult to work on, as they have often developed adhesions binding them to underlying muscle and abdominal structures.

Those very interested in this surgery should visit several scar revision websites, of which RealSelf seems to be the largest, and there are many more.  Use the Search box for the kind of surgery and scar you’d like to know more about.  You can learn much from these sites’ questions and specialists’ answers, and from the “before and after” photo albums.

With this post I include several “before and after” photos of scar revisions shown in web advertising.  I am grateful to the people and websites who make this material freely available.  They illustrate something of what can and cannot be expected of scar revision surgery.  I have posted the photos in a small format – click on them for more detail, and feel free to ask for links to the related websites.

If you are interested in this kind of surgery, be reminded that –

  • it may not result in a major improvement of your scarring;
  • not all scars can be much improved and none can be totally erased;
  • how a scar heals is critical: good care can result in better healing, but this can never be totally controlled;
  • surgeons differ greatly on what is advisable and possible – so don’t let one closed door deter you, weigh up what you are told, and if necessary shop around;
  • the finest scar revision is usually done by plastic surgeons, so ask about your surgeon’s background and check out a good range of photos of his or her work.

Appendectomy02c b4 & after RealSelfDoctor’s Note: The left image is of a 26 year old female with an ugly indented appendectomy scar from her childhood.  The second photo was taken 2 months after scar revision surgery and this scar should continue to improve with time and scar management.

Belly13c-after PSBelly13c-before PSThese images show a woman’s gall bladder removal scar before and after revision surgery after weight reduction.  In removing tissue the scar is lowered and smoothed but not reduced, and her navel has been reconstructed.

Transverse01-frontA transverse scar that has become sunken can be much improved but without a tummy tuck it’s not out of sight.  A tummy tuck requires excess skin and underlying fat that can be removed, drawing this scar closer to the pubic region.

MidlineUpper02 after

MidlineUpper02 beforeThis vertical midline scar had spread and become sunken and it is marked for removal.  The plastic surgeon has taken great care to replace it with a much tidier and thinner scar-line and will be please it has healed well.

Check01 beforeCheck01 afterThe scars left by the repair of some of the major congenital abdominal conditions of infancy can often be significantly improved in later life. Here the scars from drainage tubes have been removed as well as the old-style “railway line” scar. Again, there was no tummy tuck.

PoustiPS01b afterPoustiPS01a beforeThis 33 year old mother of 4 has a history of bowel problems and surgery which left her with a large scar, ruptured (herniated) abdominal muscles and no umbilicus. Her repairs are detailed here. She had scar revision, abdominal wall repairs, abdominoplasty (a tummy tuck)… and is understandably enthusiastic about the result.