Complex abdominal wall reconstruction is a medically necessary operative intervention that is performed by a highly-trained surgeon to relieve abdominal discomfort and pain that some people experience due to large, recurrent, and/or untreated hernias.
“When tissue and organs push their way through the abdominal wall, surgery is the only remedy that will provide relief from the condition and usually helps individuals remain hernia-free,” explains Amit S. Kharod, M.D., a general surgeon, board-certified in general and laparoscopic surgery, who specializes in complex abdominal wall reconstruction surgery.
There are various surgical options to fix complicated hernias, including suture repair, mesh repair, open repair, as well as laparoscopic and robotic surgery. “Determining which procedure will be most beneficial for each unique patient is my goal,” says Dr. Kharod.
Helping patients choose the right surgery is based on several variables. Read on to find out what factors to consider and what surgical choices you have.
Complex Ventral Hernias
A ventral hernia is a broad medical term consisting of several different types of hernias that slip through a weakened area in the abdominal wall. The most common complex form of a ventral hernia is referred to as an incisional hernia because, as its name suggests, it appears where scar tissue from previous surgeries have weakened the abdominal wall.
Severe ventral hernias require emergency surgery when intestinal tissue gets stuck (strangulated) in the hole of the abdominal wall and can’t be pushed back inside. “This cuts off the blood supply vital to the intestine, leaving the abdomen descended, swollen and painful,” explains Dr. Kharod. Incarcerated hernias also pose a real danger, as they obstruct the flow of the contents of the digestive tract, causing nausea and vomiting.
“Simply pulling together loose muscles like you would do for a tummy tuck is not enough to fix more complicated ventral hernias,” remarks Dr. Kharod. These hernias arise from very wide abdominal wall separations after muscles have deteriorated to the point of not being able to support the application of a mesh patch. “In these cases, identification and delicate rearrangement of interior abdominal muscles must take place before securing the mesh along the wall of the abdomen providing permanent reinforcement.”
What Are Your Surgical Options?
This is something that must be given careful thought during your consultation with a surgeon. Factors such as the size of your hernia, whether your hernia is recurrent, pre-existing medical conditions that could hinder the healing process, your age and weight, wound care needs, and recovery time should all be considered when choosing the type of surgery.
Suture and Mesh Procedures
For hernias smaller in size – not exceeding 6 cm – you might opt for either a suture or mesh procedure. In both cases, a surgeon will move the protruding tissue and organs inside into their original position. With suture repair, the muscles are tightly pulled together and stapled or stitched in order to close the hole that has formed. For mesh repairs, a patch often referred to as a mesh synthetic/biological prosthesis is placed over the weakened area and can reduce the rate of hernia recurrence.
Open repair tends to be the best option for those with a strangulated hernia because it is effective in a case of emergency. Generally, there are more complications associated with open repair and it requires more post-operative wound care, making it unsuitable for patients with medical conditions that inhibit healing. The operation requires pulling and tension, making a tension-free approach like minimally-invasive laparoscopic or robotic techniques a better option for some people with abdominal pre-existing medical conditions.
Minimally-Invasive Surgical Options
Patients with recurrent or larger hernias (over 6 cm), those who are younger and physically fit, as well as patients with post-operative demands like getting back to work quickly, will benefit most from the recent technological advancements in minimally-invasive surgery. It allows for surgeons to make the same tiny surgical cuts used in laparoscopic surgery, with tools attached to a robotic arm that is controlled by a computer to repair complex hernias.
“At Advanced Surgical Health Associates, our surgeons use the da Vinci Robotic Surgical System®, which helps us precisely control the movements of the miniature instruments,” says Dr. Kharod.
During robotic surgery, a specially-designed camera provides a magnified, three-dimensional view of the surgical site. The camera projects the image onto an HD monitor. The surgeon sits at a remote control console and manipulates robotic instruments while looking at the images on the monitor rather than performing the surgery manually.
There are many advantages to performing the surgery robotically, according to Dr. Kharod. “In addition to having a clear illuminated view of the surgical site, the magnification provides a close look at the patient’s anatomy and a better field of vision,” he explains.
The surgeon also has the flexibility to turn and rotate his or her wrists while operating, even in tight spaces. “The robotic arm is more malleable than hands,” says Dr. Kharod. “Unlike regular laparoscopic surgical tools, the arms bend to work on difficult to reach areas of the stomach with ease.”
Patients see many benefits of robotic-assisted surgery over traditional open surgery. “The incision site heals with less scarring, there’s a shorter hospital stay, decreased pain, and a faster recovery time allowing them to get back to their routine quickly.” However, there are many factors to take into consideration before a patient and surgeon determine what surgery is the best fit.