What is Abdominal wall reconstruction?

The abdominal wall protects the inner organs, maintains upright posture of the body, and supports the spine. The abdominal wall can be weakened with recurring hernias, traumatic injury, and non-healing open wounds. If it is left untreated, you may experience a range of abdominal complications and also impaired aesthetic appearance.

Abdominal wall reconstruction is an advanced surgical procedure that strengthens your weakened abdominal wall. It is considered as the last line of defense when other surgeries have failed to correct the problem. The surgery helps to restore the abdominal wall with enough integrity, strength, flexibility and ability to withstand the intense physical activity.

What are the types of the surgeries?

The effective reconstruction of the abdominal wall involves relocating the abdominal tissues and redistributing the muscles. There are different techniques followed based on the extent and severity of the defect. Your surgeon may use one of the following to correct the abnormality.

Grafts: Autogenous fascial grafts are used to repair the abdominal fascial defects. These grafts help in maintaining the structural integrity of the abdomen.

Bioprosthetics: Abdominal wall reconstruction using bioprosthetic material has gained very much popularity. These biologic meshes are derived from human or animal sources and are composed of extracellular matrix that is decellularized to mitigate an immune response.

Tissue expansion: The tissue expansion is an ideal technique that involves expansion of fascia in the abdominal wall. The procedure has various advantages like matching the color and contour, and minimal donor deformity.

Flaps: Mucocutaneous flaps involve reconstructing the abdominal wall with the donor skin, soft tissue and fascia. This type is also preferred in contaminated wounds for which non-absorbable prosthetic mesh cannot be used safely.

Vacuum-assisted closure (VAC) therapy: The VAC device is used to decrease infection, wound edema, and stimulate vascularization of the wound bed. It is commonly used technique for acute abdominal defects. VAC is placed to allow the bed of granulation to accumulate over the absorbable mesh. After this, split-thickness skin grafting is performed.

Which individuals are eligible for the surgery?

Your surgeon may recommend abdominal wall reconstruction in the following conditions:

• Absence of stable skin coverage on the abdomen
• Recurrence of abdominal defects even after prior closure attempts
• Compromised local abdominal tissues
• Severe visceral complications

Abdominal wall reconstruction is contraindicated if:

• You have high risk of infection
• You have diabetes
• You are planning to undergo bowel surgery

How should I prepare for the surgery?

Your surgeon instructs you to undergo appropriate laboratory test, as well as chest radiographs and ECG. A CT scan helps in determining the size and location of the fascial defects.

You should stop consuming alcohol and smoking as it can cause complications during and after the surgery. Some of the risks associated with alcohol are bleeding, infections heart problems, and longer hospital stay.

Discuss with your surgeon about the medications you are taking as few medicines may affect the recovery.

What will happen during the surgery?

The surgery may take approximately 2 to 7 hours to complete. You will be administered a general anesthesia before the procedure. Then the surgeon makes an incision on the abdomen and the abdominal muscles are repositioned to shape the abdominal wall. When these abdominal tissues are compacted, the surgeon uses special techniques to shift them and spread them out. This allows a tension free closure of a hernia. Then the surgeon inserts a synthetic or biological mesh in the abdominal cavity. The incisions are closed with non-absorbable sutures.

What is the aftercare of the surgery?

Abdominal wall reshaping is a complex surgery and hence requires a hospital stay of about five days or until the bowels return to normal function.

The postoperative experiences and recovery varies from person to person. You will be prescribed a special abdominal binder during the recovery to prevent strain on the surgical site. It is very important to wear the binder at least for one month following the surgery. You may have tenderness and swelling at the surgical site.

What are the postsurgical considerations?

Abdominal wall reconstruction is considered as a safe surgery, but there are certain risks associated with it. The common complication of any surgery is delayed wound healing and infection. You should notify your surgeon if you have:

• Sharp increase in intra-abdominal pressure
• Donor site complications
• Respiratory problems
• Chronic dysmotility of the bowel
• Fever
• Excessive bleeding
• Sever pain which cannot be controlled with the painkillers