Abdominal Wall Reconstruction (AWR) And Complex Hernia Repair

Overview

What is it? Large or complex abdominal wall hernias are a challenging surgical problem. This is because traditional repair techniques do not work on them and because if these hernias are not repaired properly they are almost certain to recur and cause further problems and/or complications. Abdominal wall reconstruction is an advanced surgical procedure that aims to restore the continuity but also to maintain the normal function of the abdominal wall. It is recommended for patients with large and/or complex abdominal wall hernias and requires specialized surgical expertise.
Why it happens: Most large or complex hernias will develop in a previously operated area either for a pre-existing hernia or for any other type of abdominal surgery. Patients would typically be obese with significant comorbidities or they will have a history of multiple failed previous hernia repairs and/or a history of a previous mesh been infected. History of abdominal trauma, fistulas, stoma bags and major previous surgeries are also common.

Symptoms

These hernias are typically asymptomatic and are rarely life threatening. Nevertheless, they are very uncomfortable as they cause a torso deformity and they have a significant impact in the patient’s quality of life.

Diagnosis

These hernias are typically evident even above the clothes. In most cases a careful medical history and a physical examination will confirm the hernia, the later margins of the defect and the mechanism by which the hernia developed. It is imperative that these hernias are scanned appropriately prior to any surgical attempt and therefore your doctor will routinely ask for a CT scan of your abdomen and occasionally an MRI too.

Treatment

There is no medication for hernias and ideally, all patients who are fit to undergo surgery should have their complex abdominal wall hernias repaired surgically. Support belts (hernia belt/truss) may be used to support the hernia however these are rarely effective in large hernias. The surgery required to repair such a hernia is termed “abdominal wall reconstruction”. It can be performed with both open and minimally invasive techniques depending on the complexity of the hernia.
These repairs require reconstruction and repositioning of the abdominal muscles and insertion of a large mesh. The exact level within the muscles in which the mesh is placed varies and there are a few different available options that are in use. The operation can sometimes last more than 7-8 hours, depending on the complexity of the repair and patient’s individual characteristics. Most patients spent the night after their surgery in an Intensive Therapy Unit or in a High Dependency monitored bed and usually spent a couple of days more in the hospital after that.
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Follow Up

If you had surgery for complex hernia
  • Patients typically return to daily activities within two to five weeks and regular exercise about six weeks after the procedure.
  • Usually there will be some drain(s) after the surgery. It is very important to follow your doctor’s instructions on how to manage these drains and to ensure that you are confident to deal with it if asked to be discharged home with a drain in situ.
  • It is important to follow all your doctor’s instructions, take any medication prescribed regularly and keep your follow-up appointments.
  • Getting out of bed and walking is an important part of recovery and helps prevent complications.
  • Take steps to avoid becoming constipated. Eat lots of fiber, drink plenty of fluids, exercise, and go to the bathroom when you feel the urge.
  • Try avoiding heavy lifting and other strenuous activity. Ask your doctor what types of activities are safe and for a timed plan on when to resume your normal lifestyle. You should also ask when you can return to work which will depend on the type of your job.
  • Do not drive before you feel safe to emergency break – check with your insurance company for any small prints in your policy.
Seek immediate medical attention if
  • Your hernia becomes painful and you abdomen becomes distended.
  • If you have nausea, fever, or vomiting along with hernia pain.
  • If you have nausea, fever, or vomiting along with hernia pain