COMPLEX ABDOMINAL WALL RECONSTRUCTION

So many medical conditions such as hernias, trauma to the abdominal wall or incisional hernias after surgical treatment may become problematic often recurring after repair. They could also be associated with infections and non-healing wounds
Play Video

Abdominal Colectomy

Play Video
So many medical conditions such as hernias, trauma to the abdominal wall or incisional hernias after surgical treatment may become problematic often recurring after repair. They could also be associated with infections and non-healing wounds
The main aim of the abdominal wall reconstruction is to restore the anatomical and the physiological functions of the abdominal wall as well as take care of the defects such as the wounds that caused the problem. Some of the physiologic functions that are compromised during the defects include the limited ability for defecation and limited protection to the abdominal viscera
The main aim of the abdominal wall reconstruction is to restore the anatomical and the physiological functions of the abdominal wall as well as take care of the defects such as the wounds that caused the problem. Some of the physiologic functions that are compromised during the defects include the limited ability for defecation and limited protection to the abdominal viscera
The multidisciplinary approaches to the abdominal wall reconstruction plus the use of fewer methods that will involve the insertion of synthetic fiber meshes to reinforce the wound are newly being employed.

Indications

  • Infections. A well functioning abdominal wall protects the internal viscera from infections by acting as a physical barrier. If this is breached, the patient is prone to many infections and sepsis. The patient is required to undergo the complex abdomen reconstruction to clear off any infections that are present and to avert any future infections.
  • The abdominal wall assists in various physiological functions such as urination, defecation and even coughing. Reconstruction means that these functions will be restored and the patient is to have once again a comfortable life.
  • In patients who have had a traumatic experience such as from road traffic accidents or industrial accidents, the reconstruction helps them to go back to the normal day to day life that they were used to.
  • Incisional hernias occur often following previous abdominal surgeries and tend to recur if not well corrected. Abdominal wall reconstruction is aimed at a permanent reconstruction that will have less of the complications such as herniation. It is strongly recommended in patients who have undergone multiple abdominal surgeries such as those who have colorectal cancers.

How is the procedure done

The procedure can be done using a variety of approaches such as fascial grafts, prosthetics, skin flaps/ flap closure, mesh closure.
The fascial grafts can be derived from the tensor fascia lata and are used especially if the overlying skin and soft tissues are intact enough as it gives a better outcome.
The use of meshes is quite advantageous as compared to the traditional approach of only suturing the abdominal layers together. It reinforces the abdominal wall and prevents herniation of the abdominal contents but comes with the cost of increased instances of infections. They can be either be placed below or above the rectus sheath depending on the deformity.
Flaps are often used for deeper full-thickness defects of the abdominal wall and in contaminated wounds.

Risks

Secondary injuries to the nearby organs during the repair process are a risk
Infections following the surgical reconstruction especially if synthetic bio meshwork is used
Graft rejection and inflammatory reactions to the implants are present in a limited number of patients.
The risk for the anesthesia should be anticipated in advance.

How you prepare for the surgery

Assessing if the patient is fit for surgery especially if they have had a cardiac issue before is mandatory. This is done through a thorough history and physical examination of the patient.
The patient should have gotten adequate antibiotic cover before the surgical procedure to avoid the risk of infections. Thromboprophylaxis should be employed to prevent thrombus formation.
You are required to show up to the health care facility about a day to the surgery. This will give the caregivers enough time to run the lab blood tests required and other tests that might be required before the surgery for a current update of the results.
Imaging studies should be done such as the CT scan. They provide the surgeon with so much information about the condition and about the previous approaches and/or implants or meshwork used in the preceding surgeries
The patient is required to fast for about 8-12 hours to avoid the complications of anesthesia.
An intravenous line is required to feed the required drugs into the body system of the patient. A water drip may or may not be employed.
Because of the nature of the surgery, the patient is required to have a temporary urinary catheter to deliver the formed urine from the urinary bladder to prevent the bladder from becoming overfull during the surgery.

Recovery after surgery

Recovery should aim at chiefly preventing infections at all cost.
The duration of recovery strongly depends on the wound factors such as the depth of the wound and contamination of the wound before surgery.
The patient should be fed small quantities of food with increased frequency slowly over the day and it should be heavily composed of proteins to aid the healing process. Malnutrition should be avoided at all cost.

Outcomes after surgery

Most of the reconstruction techniques are taken up by the patient’s body well if the ideal conditions are maintained.