A comprehensive specialist guide to abdominal wall reconstruction surgery

Abdominal wall reconstruction is a method for treating hernias, which are portions of soft tissue, typically a part of an organ, poke through a fault or weakness in the abdominal wall. In this guide, a consultant in upper gastrointestinal surgery explains how hernias occur, and how abdominal wall reconstruction addresses them.

What are hernias?

When hernias are present, there is a bulge, lump, or swelling in the stomach or top of the groin. Hernias may be painful at the touch or when straining. Most hernias occur due to wear and tear of the muscles over time, as repetitive stretching and flexing of the abdomen weaken and thin them to breakage. Anything that puts pressure on those muscles can cause a hernia, such as pregnancy, coughing fits, straining on the toilet (such as during constipation), and performing heavy lifting.

The kinds of the abdominal hernias are:

• Inguinal hernias are when fatty tissue or part of the bowel pokes through the groin and most commonly occur in men.
• Femoral hernias are also when a part of tissue or organ pokes through the groin, a little further down, but these are most common in women.
• Umbilical hernias are when fatty tissue or part of the bowel pokes through the stomach, near the belly button. They can occur in babies if the umbilical cord opening from birth is not properly sealed and when they occur in adults, they need surgical repair due to associated complications.
• Incisional hernia, where the tissue or organ pokes through a surgical wound that has not entirely healed, typically after open surgery.

Why is surgery used to treat hernias?

Hernias may not cause pain and may not affect the patient negatively, but some can be debilitatingly painful and develop worrying complications like tissue death from loss of blood supply and infection. Or, the patient may be experiencing recurring hernias. For cases like these, surgical repair is recommended.

What is abdominal wall reconstruction surgery?

Abdominal wall reconstruction is one technique to repair an abdominal hernia, which has the added benefit of repairing and reinforcing the weakness where the hernia poked through. It can be performed openly, laparoscopically, or robotically – the latter two use smaller incisions, which mean a faster recovery time, but there are cases that require an open technique, such as complex repairs. These surgeries can take up to six hours to complete

The surgery involves the surgeons making an incision over the hernia area so that they can locate the portion that is poking through. If it is an incisional hernia, then the new incision is made along the previous one. Surgeons may utilise carbon dioxide to inflate the abdominal cavity and make the area more accessible for their tools. The herniated portion is then repositioned back in its proper place and the surgeons can repair the muscle and tissue, which may include major muscles such as abdominis muscle, the external oblique muscle, the internal oblique muscle, and the transversus abdominis muscle.

Often, a bioprosthetic mesh is placed behind the abdominal muscles to support the muscles, provide structure, and perform as another layer which a hernia cannot pass through. They can be permanent or semi-permanent, and are shown to significantly reduce the risk of future reoccurrences. The incision or incisions are finally sealed with dissolvable sutures or medical adhesives and bandaged.

What happens after abdominal wall reconstruction surgery?

After abdominal wall reconstruction, patients will likely feel sore which they can manage with patient-controlled analgesia. Patients may stay a few days in the hospital for observation and recovery, during which they will be fitted with drains to remove excess fluid, but they should be able to get back on their feet within a day after the surgery. Patients are advised to not lift anything heavy for at least three weeks, with a projected total recovery time of several months.

If you are dealing with a hernia, you can consult a specialist on Top Doctors.