Wound healing problems & reusing old incision?

I'm waiting to consult a specialist to see if a daVinci hysterectomy is best for me. I've had many surgeries before so my belly is scarred in several places, the largest being a transverse bikini line incision that's been used twice & had endometriosis growing in the scar a few years ago. I understand they may have to do an open laparotomy instead of a scope surgery and I'm worried about wound healing with any incision(s). A year ago I had a C-section with massive bleeding from the incision area (because I was on heparin) and it took 3 months with a wound vac to help the incision heal from the inside out. Is it even possible to use that same bikini line incision after a wound closes from the inside out like that?

I'm sure my abdominal wall is full of scar tissue & probably endometriosis. They might leave my ovaries but recommend chemical menopause with Lupron to help me heal but I've messed up my bone density taking Lupron for years already. I can't safely take HRT due to the clotting problem, it's a really complicated situation.

Also my belly button area is very scarred from the 7 scopes I've had put in- they went above the belly button last time. So I fear I'll end up with more deformity & scarring there too. I should put in jewelry to make it prettier since it looks like a piercing gone wrong already from the laparoscopies! How many times can they poke through the belly button safely?

I need the hysterectomy because I have severe adenomyosis, endo & adhesions, urinary tract problems and heavy bleeding. I also have a blood clotting disorder that will require being on strong anticoagulants post op so I don't get life-threatening clots. I've consulted a couple of OB/Gyns & now I'm seeing a Gyn-Onc who will do the surgery (because he's more skilled at excisions, not because they're worried about cancer). I know they'll choose the safest incision for me but they don't have to live with the cosmetic & minor difficulties afterwards... I gave up on wearing bikinis long ago but I'd like to have a nice, well healed scar(s).

I'm hoping someone here has ideas or tips that will help me heal or has dealt with multiple surgeries like these?

When I had my tah/bso my doctor went in thru my old incision from a laprodectomy (sp?). When I had the lapro I had problems with the wound healing and lots of bleeding. I had to have the incision reopened due to hematomas. I did not have to have a wound vac, but did have to clean and irrigate it daily. It was left to close up on its own which it did.

Flash forward to the tah/bso. Initially I had no problems at all with that incision. I thought it healed just fine, although the incision did appear to be moving up my abdomen. A few years later when I was seeing a doctor for another problem he looked at my incision and said "I can fix that for you." So I had an incision revision. Turns out I had alot of scar tissue build up in there which caused the lumpiness. That was about 7 years ago. Today you can't even see the incision unless you're specifically looking for it. There is just a faint line right below my bikini line.

IMHO, if you have a skilled surgeon, these things can be dealt with. I'm not saying my gyn wasn't skilled, just that I think he wasn't as aware as the doc who did my incision revision. That same doc removed a cyst from my thyroid, 5 years later you can just barely make out the incision on my neck.

Good luck on your decision. Be informed and ask lots of questions. I wish I had thought to ask about the old incision, the problems I previously had and what that may do to the healing after.

I'm not sure on the laps, but I know I have had MANY and have had no issues with the belly button.

Have you considered consulting with an endometriosis specialist? Many times they deal with complex cases so besides being skilled regarding the excision of the actual endometriosis, many also have exceptional skill with regard to adhesions.

I have only had three GYN surgeries, all using my belly button. My GYN used the same belly button incision twice. My endo specialist used my prior hip incisions but for the belly button cut, he cut from center up rather than center down as my local GYN had done. He also used an adhesion barrier to help try to prevent future scar issues. I have done well for the last couple years!

I wish you all the best and hope whatever you decide is successful for you!

s

My last big endo surgery I was very pleased with the results & had an easy recovery. I had an OB/Gyn who specialized in endo, another General surgeon who was specialized in tumor removal and a Urologist all working on me through scopes plus a small appendectomy incision. They used a lot of techniques to avoid adhesions, including post-op massage & ultrasound therapy to keep new scar tissue from forming. Since then I had 2 emergency C-sections that were complicated by excessive bleeding so they had to get in & get out quickly without any nice repairs or attention to the scar. The did tell me I should see a plastic surgeon later due to the weird healing of the bikini line cut but to give it a few more months to heal. I was just lucky to have survived those last 2 surgeries... now I have HUGE problems getting worse every week. I've had ultrasounds, x-rays & CAT scans this month & they decided it's adenomyosis & adhesions plus maybe a cystic mass messing up my pelvis & kidneys.

First I consulted the clean-up team that did such a good job on me 10 years ago. They recommended a daVinci surgery since conventional laparoscopy probably wouldn't work & a laparotomy would probably have wound healing issues again, it's too soon since my last recovery. Basically they don't want to operate on me again & sent me to a daVinci specialist. I'm hoping this Gyn-Onc will be the most skilled at excision (or laser) endo removal... his specialty is removing bad stuff!

I'm in a hurry for relief so I was going to take the first available surgery date, but if it costs me lost work time due to wound healing complications, maybe I need another specialist working on me... I just noticed a few threads about plastic surgeons doing abdominoplasty during a TAH, maybe I should try to see the plastic surgeon before I schedule this surgery?