A complex abdominal wall hernia is characterized by protrusion of the contents present in the abdominal cavity due to a weakness or defect in the abdominal wall. It has a high recurrence rate and its treatment is time-consuming and technically challenging.
Characteristics of a Complex Abdominal Wall Hernia
A complex abdominal wall hernia is ≥ 10 cm in width or length. Besides, it also causes the following:
- Muscle damage and injury to the surrounding tissues
- Non-healing wounds or ulcers
- Enterocutaneous fistula: an abnormal connection between the skin and stomach or the intestinal tract
What are the Signs and Symptoms of a Complex Abdominal Wall Hernia?
A complex abdominal wall hernia may be asymptomatic. However, the common symptoms may include:
- A lump in your abdomen
- Abdominal discomfort including pain and nausea
- Bowel obstruction
- Changes in the skin
What are the Causes of a Complex Abdominal Wall Hernia?
A complex abdominal wall hernia occurs when the abdominal wall becomes weak and the layers of the abdominal muscles split apart. Thus, a gap is created where the abdominal contents, normally contained, protrude through the abdominal cavity.
A complex abdominal wall hernia may develop due to:
- Laparotomy: a surgical procedure in which a large incision is made in the abdomen
- Vascular disorders such as aneurysms, an abnormal bulge in your blood vessels
- Infection or other diseases
What are the Risk Factors for a Complex Abdominal Wall Hernia?
People with the following conditions are at increased risk of developing a complex abdominal wall hernia:
- Advanced age
- Poor eating habits
- Alcohol consumption
- Chronic use of steroids
- Chronic obstructive pulmonary disease (COPD)
Types of Complex Abdominal Wall Hernias
The different types of complex abdominal wall hernias include:
- Groin Hernias: These include femoral and inguinal hernias and are present below the groin crease.
- Umbilical/Paraumbilical Hernias: These are present at or near the navel or belly button.
- Spigelian Hernias: These are present at the side of your abdomen.
- Ventral/Epigastric Hernias: These are present along the midline between the bottom of your breastbone and belly button.
- Incisional Hernias: These can develop anywhere in your abdomen after abdominal surgery.
Diagnosis of a Complex Abdominal Wall Hernia
Your physician will review your medical history and symptoms. For further clarity, you will be recommended imaging tests. These may include:
- Barium study: For this procedure, you will be required to swallow a white viscous solution of barium mixed with water. After ingestion, barium coats the lining of your upper GI tract. It absorbs X-rays and appears as a white image on the X-ray film.
- Ultrasonography: In this technique, a gel is applied on your belly, then a device called a transducer is rolled gently on your abdomen. The transducer emits high-frequency sound waves which help generate images of internal organs and other tissues. These images are displayed and recorded on the monitor screen connected to the transducer.
- Computed tomography (CT): In this technique, X-ray images are generated with the help of a computer.
Treatment of a Complex Hernia: Abdominal Wall Reconstruction
Asymptomatic complex abdominal wall hernias may not always require treatment. However, in cases of severe symptoms, your doctor will recommend an abdominal wall repair surgery, also called abdominal wall reconstruction.
The surgery aims to close the gap in the abdominal muscles by suturing (stitching) them together and strengthening them by applying a mesh patch. The surgery is performed under general anesthesia. It can be performed by any of these techniques:
- Open approach by making a single incision or,
- Minimally invasive approach/keyhole surgery that involves making multiple small incisions and using a laparoscope (tiny flexible camera)
After the abdominal muscles are repaired, your surgeon will close the incision.
Post-Operative Care for Abdominal Wall Reconstruction
You will be required to stay in the hospital for a day or two. During this time, your recovery is monitored.
- You will be given pain-relief medications, light, and healthy diet, and your vital signs will be monitored.
- You will be discharged once your doctor is satisfied with your recovery and you can move around properly.
- You should avoid heavy-duty work after discharge and stay active through mild-intensity exercises such as walking and stretching.
Risks and Complications of Abdominal Wall Reconstruction
As with any surgery, abdominal wall reconstruction may be associated with the following risks or complications:
- Internal bleeding or blood clots
- Allergic reactions
- Injury to nearby tissues
- Collection of blood or fluid at the surgical site