What to expect from repair surgery for complex abdominal wall hernia

In this detailed look into complex abdominal wall hernia repair, renowned consultant oncoplastic and general surgeon Miss Jasdeep Gahir explains what patients can expect from the procedure itself and the recovery period that follows. The leading specialist also explains why the length and complexity of these types of operations vary from patient to patient.

What is a complex abdominal wall hernia?

Complex abdominal wall hernia is a defect in the abdominal structure that may have resulted due to previous operations. The defect occurs because there is a weakness in the fascia of the abdominal wall. Any defect that affects more than twenty per cent of the structure would be called a complex abdominal wall hernia.

These are full thickness defects in the abdominal wall and there can be a variety of them within the upper part of the abdomen due to epigastric hernia repairs or previous laparotomies. As these patients have lost that vital structure, a lot of the intestinal contents can hang out and are covered only by a soft layer of skin.

What is complex abdominal wall reconstruction?

Complex abdominal wall reconstruction is needed in patients who have this type of very large hernia. In order to repair the hernia, you have to understand the anatomy of where the muscle and the fascia as well as why it resulted in the first place; for instance, issues with nutrition, being overweight or a previous surgery that resulted in a scarred abdomen.

Before doing the reconstruction, the patient undergoes a CT scan and a multidisciplinary meeting discussion is also held to establish if the patient is suitable for the reconstruction. If we also obtain consent from the patient, we can go ahead with surgery.

Surgery involves opening the defect and pushing back the contents of it. We also find the muscle structure and see if it can be brought together with the fascia to repair the defect. If a little gap still remains, we sometimes insert a mesh to bridge the space. Typically, these are very long, complex operations and the patient may be required to stay in hospital.

How painful is abdominal wall reconstruction?

Any operation is painful, be it small or large, but we do ensure that the patient has very good pain relief after the surgery. If the patient has a very large hernia, an extensive incision may be required and an epidural may be administered or interim muscular blocks.

We inform patients thoroughly about the pain they may experience and so they are very well prepared. We always ensure that patients have been given binders and that they are taking regular painkillers and mobilising quickly after surgery to allow them to have a successful recovery.

How long does complex hernia surgery take?

In my experience, this is very variable. Sometimes we predict patients will require a very long operation but once we actually begin surgery, it is more straightforward than expected. Conversely, some patients have more bowel adhesions than appear on the CT scan and therefore surgery can take longer than first expected.

On average, complex abdominal wall reconstruction surgery can take between two to six hours to complete depending on the complexity of the individual case.

How long does it take to recover from abdominal hernia surgery?

In terms of recovery from complex abdominal wall surgery, this is comparable with that of the original laparotomy. Generally, the recovery time required is very variable and often depends on the physiological fitness of the patient. On average, patients spend up to a week in hospital following surgery.

Once patients start to mobilise again, some are up and about within a month but others may take longer than that. If the operation is shorter then recovery will be quicker. But a longer or more complex operation can have a longer recovery.

If you require complex abdominal wall reconstruction surgery and wish to discuss your individual case with Miss Gahir, don’t hesitate to visit her Top Doctors profile where you can learn more about her and book a consultation.