Abdominal wall reconstruction: Get your life back after hernia, diastasis recti surgery
February 19, 2021
All buildings need a solid foundation. If a corner of that foundation crumbles, the building will weaken. The same thing happens with an abdominal wall defect, such as a hernia or diastasis recti – muscle separation due to pregnancy.
Instead of having solid support to walk, sit, or bend, you have muscle weakness that can impair your quality of life, including back and joint pain, decreased mobility, and even self-confidence issues. Patients' with large, protruding abdomens have been mistaken for being pregnant and even accused of shoplifting items under their shirts.
Surgical repair through abdominal wall reconstruction can be successful if done appropriately by an experienced team. Many of our patients, however, have traveled a long road before being referred to our center. By the time they see us, the average patient has had eight to 15 prior surgeries or more – including as many as three to four failed attempts at hernia repair. Most have seen multiple surgeons who informed them they were out of options.
Then they find out about our abdominal reconstruction team at the UT Southwestern Plastic Surgery Clinic. Our team of experts provides transformational procedures that are more complex than those performed at most surgery centers.
We often perform two to four abdominal reconstruction procedures a week, while some centers may only perform that in a year. Approximately 60 percent of our patients travel from outside the Metroplex for our patient-centric approach. Our surgeons also partner with UT Southwestern's physical medicine and rehabilitation (PM&R) experts to decrease patients' downtime, personalize their recovery program, and reduce the risk of recurrence after complex abdominal wall hernia repair and reconstruction.
We are dedicated to helping patients realize their optimal physical function and emotional well-being. There is no one-size-fits-all approach to abdominal reconstruction and rehabilitation. The first step is a full review of your health story: your medical history, previous surgeries, professional/personal interests and goals.
Conditions that may require abdominal wall surgery
The abdomen contains many vital organs and important blood vessels that must be supported with clear functional pathways to keep patients healthy. All these systems must be protected for a successful repair.
We strive for the least invasive, most effective approach for all patients. That said, most patients will require open surgery due to extensive scar tissue or distorted anatomy often due to prior surgery. The type of procedure or surgical approach recommended – whether it employs sutures, biological mesh, muscle flaps, or a combination of those techniques – will ultimately depend on the individual patient's condition.
These are some of the most common conditions we treat with abdominal reconstruction surgery:
- Abdominal trauma: Individuals who have suffered car accidents or other severe abdominal injuries may require surgical reconstruction to regain core strength and fix damaged tissue.
- Desmoid tumors: These benign tumors in the abdominal muscle can grow large enough to disrupt digestion, movement, and even fertility. If the tumor is removed, a hernia may develop in its place. Restoring the weakened abdominal wall can result in partial or complete resolution of symptoms.
- Gynecological, urological, or gastrointestinal conditions: This may involve repairing a range of conditions, from umbilical hernias that occurred at birth to fixing damage done by failed mesh procedures or incisional hernias – a protrusion that can form as a surgical scar heals.
Read Mark McCoy's recovery story.
- Pregnancy-related issues: Abdominal distention can occur with repeat pregnancies (multiparous), twins, or a very large baby. When the abdominal wall is excessively stretched, the muscles may not recover properly, causing a bulge that looks like a hernia or a permanent pregnant belly (diastasis recti). This condition can lead to poor self-esteem and back or joint pain. Our surgical repairs are highly effective at repairing the defect (hernia) and restoring functional capability with next to no rate of hernia recurrence.
Read Kathleen Pritchard's story: ‘Fixing mommy’.
- Post-transplant: Some patients develop abdominal wall defects (hernias) after organ transplant surgery. It can be related to large incisions or if the donated organ is slightly too large for the recipient's body, resulting in an incisional hernia. We have even partnered with other DFW-area medical centers to provide abdominal reconstruction for these patients.
After surgery, patients generally recover in the hospital for a few days to a week before going home and starting physical therapy. With proper rehabilitation, most patients can achieve pre-injury levels of activity within three to six months. Every patient is different, and we have candid discussions with each patient based on their pre-operative evaluation.
Occasionally, surgery may not be the safest choice for a patient's condition. For individuals with multiple risk factors (comorbidities) or many previous surgeries, another procedure may be deemed too risky and could make the condition worse.
Know that if we recommend against surgery, it's because we've considered all the options with you and with our team of experts. In that instance, we often will help you find a nonsurgical care plan with our PM&R team that may help with your symptoms.
Setting you up for success
With abdominal wall reconstruction, certain health factors can increase the risk of complications such as infection, heart or breathing issues, blood clots, or recurrence.
With each attempt at reconstruction, the risk of recurrence increases by 10 to 20 percent, so it is important to optimize your health as much as possible before we perform surgery. We typically focus on managing four major risk factors:
Obesity is perhaps the strongest predictor of complications with abdominal wall reconstruction. For example, if your body mass index (BMI) is 35 or higher, an abdominal reconstruction procedure will almost certainly fail.
However, losing weight before surgery can substantially improve outcomes. Reducing your BMI to below 35 can cut the risk of recurrence, infection, and cardiac events related to surgery by 50 percent.
We recognize losing weight is not as easy as "eat right and exercise." Your care team will help set manageable goals based on your needs and motivation. All patients get access to a team of providers to help with each step toward recovery.
Depending on your needs and condition, your care team may include nutrition experts, gynecologists, urologists, gastroenterologists, or oncologists. However, our PM&R department will almost always be involved in your care.
PM&R focuses on full-body functional restoration. UT Southwestern was among the first medical centers to explore the importance of physical rehab after abdominal reconstructive surgery. We reported in a 2015 study that implementing a rehabilitation program resulted in approximately 20 percent lower recurrence rates and a nearly 30 percent lower rate of complications.
Just as you would do rehab after knee, hip, or shoulder surgery, you'll need to strengthen your abdominal wall after reconstructive surgery. The expert doctors and therapists in our PM&R team will create a personalized plan to help improve your range of motion and strengthen your core – the muscles in your abdomen, back, and glutes.
Stretching and maintaining strength during the weeks and months of recovery can help reduce discomfort, increase blood flow, and improve your ability to safely perform daily activities, such as sitting up, getting out of bed, and walking.
Get your life and confidence back
UT Southwestern can provide advanced surgical care because we work as a team. Every patient we treat gets access to a wide range of providers with specific expertise who can address all their health needs. So many factors coalesce to determine a patient's outcomes.
The patient's motivation is still one of the biggest keys to success. Pairing your efforts with our team approach can result in lifechanging outcomes. We've helped patients regain the ability to do a variety of normal activities, from standing in their kitchen cooking meals to exercising and returning to work.
Most importantly, they get back to doing what brings them joy: getting down on the floor to play with their kids, feeling confident enough to go on dates, and being able to start families.
Seeing these results is one of the most rewarding aspects of my surgical career. You can see it in patients’ faces and their whole demeanor when they return for follow-up visits. It’s why we do what we do.