Abdominal wall reconstruction at Parkside Hospital

What is abdominal wall reconstruction?

Abdominal wall reconstruction is surgery to rebuild and strengthen the layers of muscle and tissue that support your stomach area, usually after a hernia, an injury or a previous operation has left it weakened. It aims to close the gap causing the problem and restore the integrity of your abdomen.

What conditions does it treat?

You might be offered abdominal wall reconstruction if you have:

• complex or recurrent hernias, including ones that have come back after an earlier repair
• incisional hernias, which develop through a weakened surgical scar
• inguinal hernias in your groin, or ventral hernias at the front of your abdomen
• parastomal hernias, around a stoma or ileal conduit (an opening made during surgery to drain waste to the surface of your skin)
• an enterocutaneous fistula, where a channel forms between your bowel and your skin
• loss of abdominal domain, where a large portion of your organs sit outside the abdominal cavity in a hernia
• diastasis recti, a separation of your abdominal muscles that can follow pregnancy
• weakened or damaged tissue after infection, trauma, tumour removal or an organ transplant
• infected surgical mesh from an earlier repair, or long-term groin pain caused by weakened tissue.

What are the benefits of having abdominal wall reconstruction?

Abdominal wall reconstruction can repair hernias and defects that are too large or too complex for standard hernia surgery to put right. Rebuilding the muscle layers can restore your core strength and improve your abdominal shape, while also relieving the discomfort a large hernia can cause. Where mesh is used to reinforce the repair, this lowers the chance of the hernia returning.

Choosing a keyhole or robot-assisted approach, where this is suitable for you, is also linked to less trauma to the surgical site, fewer complications and a quicker return to normal activity than open surgery.

Are there different types of surgical approaches?

There is more than one way to rebuild the abdominal wall, and your surgeon will choose the approach that suits your hernia and your health. Component separation releases the layers of your abdominal muscles so they can be brought back together at the middle of your body, restoring a natural shape without needing a large piece of mesh.

Many repairs also use a mesh, made from either synthetic material or biological tissue, to reinforce the area and reduce the chance of the hernia returning. For bigger or more complicated defects, your surgeon may instead take a flap of your own tissue, complete with its own blood supply, to rebuild missing coverage. This is a more involved, microsurgical technique that can also improve the shape of your abdomen.

Your surgeon may also be able to offer this surgery as open surgery, through one larger cut, or as keyhole or robot-assisted surgery, using several smaller incisions. Keyhole approaches can include techniques that reach the hernia from outside the lining of the abdominal cavity, and robotic methods that loosen one of the deeper abdominal muscles to help close larger gaps.

What happens before the operation?

Before booking your surgery, your surgeon will review your history of hernia repairs, look at your scans and talk through the options for mesh, flap or muscle-releasing techniques with you. If you smoke, have diabetes or carry extra weight, your team may also work with you on this beforehand, since these factors affect how well you heal.

In the days before surgery, you will usually need to:

• stop eating and drinking for at least eight hours beforehand
• stop smoking for at least two weeks before your operation, since smoking reduces the oxygen your tissues need to heal
• check with your doctor whether to keep taking your regular medicines, as some affect how your blood clots
• arrange transport home and ask someone to stay with you on the first night after surgery.

What happens during the procedure?

Abdominal wall reconstruction takes place under general anaesthetic and usually lasts two to six hours, depending on how complex your repair is. Here is what typically happens:

1. Your surgeon makes either one longer cut in your abdomen, or several smaller cuts if you are having keyhole or robot-assisted surgery.
2. The layers of your abdominal muscle and connective tissue are carefully separated and moved back into their natural position, closing the gap causing your hernia.
3. Surgical mesh is usually placed to reinforce the repair and support your tissue as it heals. For larger defects, your surgeon may use a flap of your own tissue instead, taken with its own blood supply to rebuild the area.
4. The wound is closed, and a drain may be put in to clear away fluid while you recover.

What does recovery look like?

How long you stay in hospital depends on how complex your surgery was, ranging from around one or two nights for more straightforward repairs up to about five days for more complex cases. Your care team will monitor your healing, help manage your pain and support you to get moving safely before you go home. You may have to go home with a drain in site, but this depends on your individual surgery.

Once home, you will need to avoid lifting anything heavy or doing strenuous activity for the first few weeks, building back up to normal movement gradually. Most people return to their day-to-day activities within two to five weeks, and to regular exercise by around six weeks. If you had a drain fitted, this is usually removed at a follow-up appointment, and it is important to attend all your follow-up appointments so your team can check how you are healing.

What are the risks and complications?

As with any operation, abdominal wall reconstruction is an invasive procedure that carries some risk. Possible complications can include:

• a reaction to the anaesthetic
• blood loss during the operation
• infection.