Abdominal wall surgery includes a group of surgical techniques developed to solve primary (hernias) or postoperative (eventrations) alterations in this location.
Given the anatomical relationship of the abdominal wall with the abdominal organs, this surgery is also used to treat more complex pathologies such as cutaneous fistulas originating inside the abdomen, which go through the abdominal wall and exit to the skin.
In short, the objective of these operations is to restore the structures of the abdominal wall to recover its functional characteristics as a barrier between the intra-abdominal contents and the skin.
In what cases is abdominal wall surgery performed?
There are three types of abdominal wall pathologies:
- Hernias: The inguinal orifice, a normal anatomical structure, is made wider by a rupture (straining) allowing the passage of intra-abdominal contents (omentum, small intestine) with the risk of strangulation of these contents through the orifice.
- Eventrations: similar to hernia, but the outflow of intra-abdominal contents does not occur through an anatomical orifice, but through incisions that have been made in previous surgeries.
- Organ-cutaneous fistulas: fortunately much less common than hernias and eventrations. It is a communication between an intra-abdominal organ such as the intestine and the cutaneous surface, logically crossing the abdominal wall.
Hernias and eventrations cause the patient pain and discomfort, in addition to functional problems (the abdominal wall functions properly as a whole and a hole makes it impossible), but the main risk is that the intestine herniates and cannot be reduced, which can lead to its suffering (strangulation) requiring urgent surgery.
The diagnosis of most of these diseases is clinical, so that a visit to a specialist surgeon may be sufficient to indicate surgery. In cases of diagnostic doubt or if needed to consider the appropriate surgical technique, imaging tests such as Ultrasound or Computerized Axial Tomography (CT) are used.
Surgery for hernias, eventrations and fistulas
The only treatment for abdominal wall alterations is surgery. Although it is a very frequent operation, there are complex cases in which the hernial orifice is large, it is located in a complex region, in recurrence surgeries (multioperated) or when the approach is indicated by minimally invasive techniques, the surgeon’s experience is essential to ensure minimal complications and the best postoperative results.
Preparation for abdominal wall surgery
Obesity is the factor most associated with postoperative complications and poorer surgical outcomes. Pre-operative weight loss is essential. The other factor that is highly related to obesity is tobacco consumption. It is highly advisable to abstain from smoking for at least one month before surgery.
The correction of these two factors considerably improves the results of reparative surgeries and decreases the risk of recurrence.
What does abdominal wall surgery consist of?
Surgery to correct abdominal wall pathology must identify the musculoaponeurotic wall defect, reduce the hernia, repair the defect and reconstruct function.
Numerous publications have shown that the outcome of hernia and eventration surgery is improved with the use of meshes. The meshes (whether synthetic, hybrid or sometimes biological) provide greater consistency and duration to the closure of the abdominal wall, increasing its effectiveness and reducing the risk of recurrence.
They are fixed to the abdominal wall by suture or glue. In your particular case, the surgeon will explain if it is indicated and what type of mesh.
Organo-cutaneous fistulas are characterized by a much more complex surgical treatment. In these cases, the idea should be discussed individually with the surgeon in consultation. Intestinal resection will probably be necessary in addition to the previously mentioned.