Question: Name of Patient : Mrs. XXXX Female -64 weight : 68.5 kg.
No. of children: 5 (4 females and 1 male, all alive)
1992 - detected hyper thyroid
1994 - Hysterictomy carried out due to fibroid uterous
1995 - Hypertension
1998 - cholestrol

All above ailments are well under control under regular medical treatment.

January 2015- Under went explotory laparatomy right retropetoneal Lipomatous Tumor of abdomen by a GI surgeon of Astha Oncology Hospital, XXXXXXX (India) .HPE by Astha Oncology findings : Well differentiated Liposarcoma/a typical lipomatic tumor. Second and third opinion -HPE by Dr. XXXXXXX Borges of SRL Diagnostic Centre, XXXXXXX and Tata Memorial Centre, XXXXXXX ruled out of malignancy/liposarcoma - Remarks a "Gigantic Lipoma". Post operative follow-up carried out after 3 months of survery with USG Abdomen and pelvis - report N.A.D., after 6 months CT Scan was taken - result N.A.D. - after further 6 months USG was carried - result N.A.D. CT Scan was again crried out in January 2017 which showed no abnormalty.

In February 2017 detected with diabetes-2 - under control with medication.


PRESENT ISSUE

1. From mid May 2017 she suffered from mild abdominal pain. Her USG Abdominal and Pelvis was carried out on 17.6.2017 revealed “ Incisional hernia of umbilical region – size of defect 55 mm” (file attached – name - PRESENT_2017_hernia_USG)
2. To get second opinion on this, the Oncologist who had operated her for removal of retroperitoneal lipomatous tumor in 2015 was consulted. As per his advice, CT scan was done which revealed “ Incisional hernia at umbilicus level with herniation of omentum – defect size 42 mm”. (File attached – name - PRESENT_2017_hernia_CT_SCAN_HCG). When asked, whether togo for operation against hernia suffered by the patient, he said IT IS NOT NECESSARY AND ADVISED USE OF ABDOMINL BINDER BELT FOR ABOUT A MONTH and take one capsule (ESOMEPRAZOLE DR AND LEVOSULPIRIDE ER 40+75 MG.) daily in morning after breakfast and consult after one month.
3. However, as per verbal opinion of other MS surgeon when shown the USG Abd. and Pelvis report of the patient, he opined that patient requires “ repairs and prolene meshplasty”.

OUR QUESTIONS –
1. As an Oncologist what would you suggest considering different opinions given by an Oncologist (GI) and an MS? Do we need to Wait & Watch as suggested by Oncologist? OR get it operated as suggested by MS?
2. IF we go with wait and watch then:
· How wait and watch situation can help in this case? Does it lead to automatic healing? What is the purpose?
· With wait and watch situation what are the chances of facing an emergency?
· What is the safe period for observing such wait and watch, how long ?

3. If we go with surgical operation then:
· Which method of treatment should be best suited considering medical history of patient and present health condition shared above? We have heard that meshplasty is one of the successful method of treating this ailment. What do you suggest?
· Based on the type of treatment, could you share, what are the short/long term health implications considering the quality of life post operation. For example, chances of recurrence as ONE CANNOT GO FOR REPETITIVE SURGERY LOOKING TO AGE AND HEALTH OF PATIENT, ALSO INOLVED WITH COST AND RISK FACTOR.

Hello Dr. XXXXXXX

Thank you for your response. As suggested, if we go ahead with operation, then, could you please clarify what are the short/long term health implications considering the quality of life post operation?
For example, chances of recurrence as ONE CANNOT GO FOR REPETITIVE SURGERY LOOKING TO AGE AND HEALTH OF PATIENT, ALSO INOLVED WITH COST AND RISK FACTOR.

Thanks.