Abdominal Wall Reconstruction

By Hatem Abdallah, M.D.
General Surgeon

A hernia is a defect, or hole, through which tissues or organs may protrude through resulting in the appearance of a bulge. One of my areas of clinical interest is in the management of ventral abdominal wall hernias. These can occur from prior operations and are termed an “incisional hernia”. Abdominal wall hernias are a very common problem in the United States with nearly 400,000 ventral abdominal wall hernia repairs performed every year in the U.S. alone.

Incisional hernias are very common in up to 20% of open surgeries. Emergency surgery, obesity, diabetes, blood loss or infection are some of the many factors leading to an incisional hernia. Additionally, the surgical technique used for closing the abdomen after surgery has also been shown to contribute to the chances of developing an incisional hernia. New recommendations suggest using smaller sutures, smaller needles and generally taking a little extra care in closing following an abdominal surgery. Studies show the new recommendations can reduce incisional hernia rates from 20% down to 10% or less.

Just like most any other health problem, the best treatment is prevention. For patients who I see at my practice with larger hernias, more than 5 cm wide, abdominal wall reconstruction surgery may be a good option. This surgery involves using the abdominal wall to the patient’s advantage. By making incisions to release the various muscle layers at certain anatomical points, we are able to close these hernias successfully. This involves placing a mesh between the muscle layers. The mesh acts as an extra support while your body forms scar tissue around it acting like the concrete. The mesh itself is not a layer of strength, it is your own body’s ability to heal that forms the true strength of the repair. There are various types of abdominal wall reconstruction depending on the anatomy of the hernia itself. Other factors to consider for abdominal wall reconstruction are the complexity of the hernia, body mass index (BMI) as well as diabetes, heart and lung issues.

Another technique used in performing these procedures involves utilizing robotic surgery. MUSC Health Florence Medical Center is proud to be bringing robotic surgery as another tool to help patients. This option may be used to help patients who may not be able to tolerate an open operation to ensure a durable, safe hernia repair. For healthier patients, robotic surgery can be a good option instead of an open operation. This holds true for groin hernias as well. The world of hernia knowledge and research has truly expanded exponentially over the last 10 years. We are now able to fix complex hernias using minimally invasive robotic techniques, which are otherwise more technically difficult to perform through traditional laparoscopic techniques. For those who suffer from these hernias, I am happy to offer a variety of surgical options including open, laparoscopic as well as robotic techniques. Not all hernia repair techniques are appropriate for everyone. Each patient should have a customized surgical approach for their hernia and overall health needs.

For more information call Dr. Hatem Abdallah, at MUSC Health – Floyd Medical Group in Florence, at 843-669-1220.