February 6, 2012 ~ James Fico had a problem. The Sarasota Herald-Tribune (here) reports on the North Port man’s basketball-size hernia that protruded from his belly for more than five years. (Caution- the photos in this article are not for the weak of heart).
Unfortunately for Fico, 62, he had had a major heart attack and kidney cancer and could not be treated for the hernia as he was on the mend. Also complicating his care was the fact that he was unemployed and did not have medical insurance.
In January, Vascular surgeon, Jonathan Yunis, M.D., from Sarasota Memorial Hospital, performed a two-hour hernia repair. Dr. Yunis specializes in hernias and does some 500 surgeries every year. He even travels to remote areas of the world to perform hernia surgery, but he says he had never seen a hernia the size of the one he repaired in Fico.
To do the complex operation, Fico’s intestines had to be put back into his body and the opening in the abdominal wall was closed with a biologic mesh, Strattice, made by LifeCell (here). Dr. Yunis tells MDND he chose a biologic because of the lower risk of infection.
Strattice is made from pig skin that is processed to take out the living tissue leaving behind pure collagen. Biologics have a lower risk of infection, but a higher risk of recurrence than plastic, he says. Dr. Yunis says he would never use the AlloDerm biologic mesh in hernia repair as was used in Sheri Ragan, see her Patient Profile (here).
Obesity, diabetes and smoking all complicate any hernia repair. Before surgery, Fico had to lose about 100 pounds (he was 355 pounds). That was vital to his survival because as he gained weight after his heart attack and cancer, the hernia grew larger. With the size of the hernia coupled with Fico’s lack of insurance, most doctors didn’t want to touch it.
Dr. Yunis had to create a new abdominal wall, he tells the newspaper, which he reinforced with mesh. Plastic polypropylene mesh carries a high risk of infection, though he blames failures with polypropylene mesh largely on his colleagues more than the manufacturers. He believes some surgeons use the wrong mesh for the wrong hernia.
“With obesity and previous abdominal surgery, mesh can get infected,” Dr. Yunnis tells MDND. Using synthetic mesh laparoscopically the risk of infection is low, but we couldn’t do it that way on this patient. With Strattice I’m not worried about the bad complications of mesh.” #
Dr Jonathan Yunis
On staff at Doctor’s Hospital of Sarasota and runs the Center for Hernia Repair in Sarasota.