Complex Abdominal Wall Reconstruction and Hernias
Composed of layers of tissue, fat and muscle, the abdominal wall protects many of our internal organs. Its muscles are important to many vital functions, including respiration, urination and generally stabilizing the torso. This is a common place for a hernia to occur. When complex hernias appear or previously repaired hernias reappear, reconstruction of the abdominal wall may be needed to restore these muscles’ integrity, allowing them to function properly. The most common reason to perform this surgery is to repair an unsuccessful hernia surgery.
Abdominal wall reconstruction: abdominal wall reconstruction surgery is most often performed for hernia repair and is done under general anesthesia. Patients will receive specific directions from their surgeon as to when they need to refrain from eating, drinking and smoking prior to surgery and what medications to take. The surgery begins in the lower abdomen, where the surgeon can reshape the tissue into its natural position. Surgical mesh may be used to reinforce the muscular structure. Depending on the complexity of the case, the surgery may take between two and six hours. Patients generally remain in the hospital for about five days post-surgery. It’s important to follow all of your doctor’s directions and attend follow-up appointments.
Conditions that may require abdominal wall reconstruction:
- Complex hernia
A hernia is a bulge that appears in either the groin or the abdomen when an organ pushes through an opening or weakened area in the muscle or tissue, such as the abdominal wall, that generally holds it in place. Hernia repair is a very common surgery done to relieve pain and prevent complications that could become serious, especially if the hernia is enlarging. Watching and waiting may be what’s recommended if the hernia is small and isn’t bothering you, but hernias are generally treated with surgery.
There are three types of surgery typically recommended for hernia repair:
Open hernia repair: Various types of anesthesia are used for this procedure, including local, sedation and general anesthesia. When you and your doctor decide on which to use, you will get directions as to how to prepare for surgery. The procedure involves making an incision in the groin or abdomen, depending on where the hernia is located, pushing the protrusion back in place and reinforcing the area that is weakened with synthetic mesh and stitches. Most patients can go home the same day as surgery and will be able to return to exercise and other strenuous activity in four to six weeks.
Laparoscopic hernia repair: This procedure requires general anesthesia and your doctor will inform you when to stop eating, drinking, etc. prior to surgery. For the surgery, a thin tube with a tiny video camera called a laparoscope is inserted in a small incision. The camera transmits images of the surgery for the doctor to see on a video monitor in the operating room. In order to make room for your doctor to view the surgical area, harmless gas is used to inflate the patient’s abdomen. The surgeon inserts tiny surgical tools through other small incisions , pushing the protrusion back into place and using surgical mesh and stitches to reinforce the area. Patients tend to experience less scarring and less pain with this procedure. The recovery time is shorter, with patients going home the same day and taking just one to two weeks to recover, though doctors recommend waiting longer to return to strenuous exercise.
Robotic surgery hernia repair: Much of the protocol of robotic surgery hernia repair is the same as laparoscopic hernia repair. This procedure requires general anesthesia and your doctor will inform you when to stop eating, drinking, etc. prior to surgery. Like in laparoscopic surgery, a thin tube with a tiny video camera called a laparoscope is inserted in a small incision. The camera allows visualization of the area for the doctor to see on a video monitor in the operating room, but in robotic surgery, the images are three-dimensional, rather than the two-dimensional images transmitted in laparoscopic surgery. In robotic surgery, the surgeon performs the operation from a console. Patients tend to experience less scarring and less pain with this procedure. As in laparoscopic hernia repair, the recovery time is shorter, with patients going home the same day and taking just one to two weeks to recover, though doctors recommend waiting longer to return to strenuous exercise.
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