Complex abdominal wall hernia surgery

What is a Complex Abdominal Wall Incisional Hernia?

An incisional hernia occurs when tissue or part of the intestine pushes through a weakness in the abdominal wall at the site of a previous surgical incision. In some cases, these hernias become complex due to their size, location, recurrence, or associated complications such as infections, fistulas, or loss of abdominal wall domain (when internal organs no longer fit easily back inside the abdomen).

These hernias often cause significant discomfort, limit daily activity, and may affect quality of life. Complex cases often require advanced surgical techniques and careful pre-operative planning.

Why Do Incisional Hernias Occur?

Incisional hernias can develop months or even years after abdominal surgery. They occur when the layers of the abdominal wall do not heal properly or weaken over time.

Common reasons include:

  • Poor wound healing after the initial surgery

  • Infection at the incision site

  • Increased abdominal pressure from coughing, straining, or heavy lifting

  • Obesity, which puts extra strain on the abdominal wall

  • Multiple abdominal surgeries, which increase the risk of weakening the tissue

Risk Factors for incisional hernia development

Certain conditions and lifestyle factors increase the likelihood of developing an incisional hernia:

  • Obesity

  • Smoking

  • Diabetes

  • Poor nutrition or malnourishment

  • Use of steroids or immunosuppressive medications

  • Chronic coughing or constipation

  • Previous hernia repairs that have failed (recurrence)

Symptoms

Symptoms vary depending on the size and severity of the hernia. They may include:

  • A visible or palpable bulge at or near the site of the previous incision

  • Pain or discomfort, especially when lifting, coughing, or standing

  • Abdominal pressure or heaviness

  • Digestive issues such as bloating or constipation

  • In severe cases, bowel obstruction or strangulation (a surgical emergency)

Surgical Repair Options

Treatment of complex incisional hernias typically involves surgical repair, which can be performed in different ways depending on the hernia characteristics and the patient’s overall health.

Surgical options include:

  • Open repair: A traditional method using a larger incision for full access to the hernia site

  • Minimally invasive (laparoscopic or robotic) repair: In selected cases, smaller incisions and a camera-guided approach may be possible

  • Component separation: A technique used to mobilise abdominal muscles to close large defects

  • Mesh reinforcement: Synthetic or biologic mesh is often used to strengthen the repair and reduce the risk of recurrence

The Role of Mesh

Mesh is a crucial component in complex hernia repair. It provides structural support to the abdominal wall and helps reduce the risk of the hernia returning. Mesh materials vary in type and placement (onlay, inlay, sublay), and selection depends on the individual case.

We use proven, biocompatible mesh materials and tailor the approach to suit your specific needs, aiming to balance strength with the lowest possible complication rate.

Pre-operative Optimisation

Surgery for complex hernias carries risks, and outcomes are greatly improved when patients are optimised before surgery. We work closely with you and, where appropriate, a multidisciplinary team to:

  • Achieve weight loss (even modest reductions can make a big difference)

  • Support smoking cessation

  • Control diabetes and other medical conditions

  • Improve nutrition and correct any deficiencies

  • Encourage physical conditioning where possible

  • Strategies to increase abdominal capacity, including botox injection and progressive keyhole stretching of the abdominal wall (progressive pneumoperitoneum)

This process reduces the risk of wound complications, infection, breathing problems, and hernia recurrence.

Our Approach

Siobhan offers a comprehensive and tailored approach to complex abdominal wall reconstruction. This includes:

  • Thorough pre-operative assessment and optimisation

  • Evidence-based surgical techniques

  • A commitment to long-term outcomes and patient support

If you have been diagnosed with a complex incisional hernia, or have had previous hernia repairs that failed, we are here to help. Contact us to arrange a consultation and discuss your personalised treatment plan.