The front portion of the abdomen (the anterior abdominal wall) is a unique structure consisting of overlapping muscles and tendons that provide both static (standing still) and dynamic (moving) strength to the human body. This architecture provides stability, supports and protects the intestines, and still allows flexibility to assist with breathing and movement.
Fitness enthusiasts, athletes and physical therapists alike commonly refer to the abdominal wall as “the core.” Injury, damage or collapse of this structure can result in back pain, discomfort or imbalance.
Many patients with a variety of intestinal, solid organ, and gynecologic problems require abdominal surgery. While many of these operations can be performed laparoscopically (i.e. utilizing a small camera and small incisions), larger surgeries often require an incision called a laparatomy. This incision can sometimes disrupt normal muscle and tendon attachments to the abdominal wall, leading to an incisional hernia; some studies suggest up to 1 of every 10 patients who undergo abdominal surgery experience this complication.
Once a hernia occurs, it can worsen. Large hernias can lead to significant stress on the spine and back pain, which can be debilitating and make exercise or the activities of daily living challenging. Hernias can also expand, leading to worsening symptoms. In some cases, hernias can cause the intestines to twist, leading to bowel obstructions that constitute a serious surgical emergency.
Often, when patients require abdominal surgery in the setting of severe infection or trauma, the normal architecture of the abdomen is vastly distorted, which makes closing the skin surgically impossible. These types of wounds are often healed by a method that leaves significant scarring, deformity or instability of the abdominal skin. This often leads to leakage of intestinal contents directly through the front of the abdomen. The condition (known as enterocutaneous fistula) can be exceptionally challenging to treat, often requiring months of bowel rest, intraveneous nutrition and multiple operations.
Surgeons commonly use a prosthetic mesh repair technique to repair hernias. Although this is often very successful for small hernias, in many cases with larger hernias, studies have shown very high recurrence and complication rates.
Some studies place the rate of recurrence after such repairs at more than documented that first-time repairs of large hernias using prosthetic mesh have recurrence rates of over 24 percent for first-time repairs, with second or third attempts higher than 35 percent.
While prosthetic mesh repairs do create a barrier to “plug” the hernia, they do little to restore the normal architecture of the abdomen and restore function.
Since 2008, Scripps Clinic surgeons have developed a team approach to repair large abdominal wall defects and enterocutaneous fistulas, utilizing expertise in both plastic and general surgery. The abdominal component separation technique not only repairs the hernia, but also restores the natural muscular attachments of the abdominal wall.
In this technique, the hernia is repaired by repositioning the patient’s abdominal wall muscles to restore normal anatomy. The position of these muscles is reinforced internally with a biologic mesh made of animal tissue that is ultimately absorbed into the body post-surgery. Because no synthetic material is used in this surgical technique, the risk of infection is minimized.
Benefits of this technique include:
- Focus on utilizing healthy tissues with good blood supply
- Restoration of strength and support in the repositioned abdominal muscles
- Re-creation of abdominal wall, allowing for flexibility and dynamic support during breathing and activity
- Exceptionally low rate of recurrence