Abdominal wall reconstruction

Abdominal wall reconstruction (AWR) is for people with hernias that are simply too large, too complex, or too recurrent to fix with a standard keyhole repair. These are often hernias where the muscles of the abdominal wall have separated so widely that they cannot be brought back together without releasing some tension first.

The technique used is called a component separation — specifically, a posterior component separation using a procedure called transversus abdominis release (TAR). In plain terms, this means one of the deeper muscle layers on each side of your abdomen is carefully released, which gives the muscles enough slack to be sewn back together in the midline. A large mesh is then placed in the space behind the muscles to reinforce the repair. This is performed both as an open operation and using the robotic technique, which uses small incisions and a magnified 3D view.

• A large, complex hernia where so much of the abdominal contents have shifted into the hernia sac that there is no longer room to simply push them back — this is called "loss of domain"
• A hernia that has returned after two or more previous repair attempts
• A hernia opening wider than about 10 cm, which is too large to bridge safely with a standard keyhole mesh
• A hernia in an area where a standard synthetic mesh cannot be used — for example, in a field with previous infection or bowel involvement — where a biological or special mesh is needed instead
• A parastomal hernia (a hernia around a stoma) that needs a formal, structured reconstruction rather than a simpler mesh
• A wound that has broken down after a previous operation, leaving the muscles separated and needing formal repair

• Rebuilds your abdominal wall so it looks and works the way it is supposed to — muscles back in the midline, bowel properly supported
• The mesh is placed in the retromuscular plane (behind the muscle) — a position supported by published recurrence data for complex hernias
• When done robotically, small cuts are used rather than a large open incision — in published series, this is associated with less pain and a quicker recovery
• Specifically designed to solve "loss of domain" — it creates enough muscle slack to close the gap without pulling or straining
• For patients who do well, comfort, core stability, body shape, and ability to do everyday activities often improve
• For people who have already been through one or more failed repairs, AWR is one of the few remaining options for a structured rebuild

This is a more involved operation than a standard hernia repair, and you deserve a frank conversation about what that means. Here is an honest summary:

• Wound infection and healing problems — for open (non-robotic) cases, these occur in about 10–20% of patients. Skin over large hernias can be fragile and slow to heal. Your personal wound risk will be discussed before surgery.
• Seroma (fluid collecting under the skin) — this is common after abdominal wall reconstruction, happening in more than half of cases. It can look alarming — like the hernia is back — but most seromas settle on their own over several weeks without any treatment.
• Mesh infection — occurs in about 2–5% of cases. If the mesh becomes infected, it may need to be removed, which is a serious complication requiring further surgery.
• Ileus (the bowel being slow to "wake up" after surgery) — common after large open repairs. It means you will feel bloated and not hungry for a few days, and you may stay in hospital longer than expected.
• Hernia recurrence — in published series, around 10–20% over five years for these complex cases, with rates depending on the size of the defect and the quality of the surrounding tissue. Recurrence is worth knowing about, but the structured rebuild aims to give the most durable repair available for hernias this large.
• Skin or flap necrosis — in very large open repairs, the skin over the repaired area can occasionally lose its blood supply and break down; this is carefully managed with wound care.

If you take blood thinners, diabetes medication, GLP-1 weight-loss injectables, or iron supplements, please flag this when you book — these need specific adjustments before the procedure. Full details are in the guide above.

• A CT scan with 3D reconstruction — this gives a detailed map of your abdominal wall so the operation can be planned precisely before you arrive in theatre
• A review by the wider team — including nutrition, anaesthesia, and wound care specialists — to make sure every aspect of your care is coordinated
• Optimising your weight and stopping smoking before surgery: for this particular operation, these are not suggestions — they make a real difference to your healing and your risk of complications. The practice team will support you with this.
• Bowel preparation (a clearing-out drink the day before) if there is any chance bowel needs to be resected as part of the repair
• Antibiotics before the operation to protect against infection — this will be arranged for you

• You will be admitted to Warringal Private Hospital or Epworth Eastern and given a general anaesthetic — you will be completely asleep. The operation typically takes between 2 and 5 hours depending on the complexity of your hernia.
• Any scar tissue inside the abdomen is carefully separated first (called adhesiolysis) to free the bowel and give a clear view of the hernia.
• The component separation (TAR) is then performed — the deeper muscle layer is released on each side so the muscles can come together without strain.
• The hernia sac is removed, and a large mesh is placed in the space directly behind the muscles — a position called the retromuscular or sublay plane. This is the preferred location for mesh in complex repairs because it is well supported by surrounding tissue.
• The midline muscle layer is sewn closed over the mesh, and drain tubes are placed under the skin to prevent fluid from collecting. The skin is then closed.
• You will wake up on the surgical ward. For very complex cases, a night in a high-dependency or step-down unit may be needed for extra monitoring — this will be discussed with you beforehand.

• Days 1–3 in hospital: You will be encouraged to get up and walk as soon as it is safe — usually on the day after surgery. This is part of a structured approach called an enhanced recovery program (ERAS), which helps prevent complications and speeds up healing. Your pain will be managed carefully throughout.
• Going home: For robotic cases, most people go home on day 3–7. For large open repairs, expect 7–14 days in hospital. You will not be discharged until you are comfortable, eating and drinking, and your wound looks good.
• 4 weeks: A wound review appointment — healing is checked and any remaining sutures are removed if needed. You must wear your abdominal binder (a firm, wide support wrap around your belly) for 8–12 weeks — this is not optional; it protects the repair while the mesh integrates into the tissue.
• 4–8 weeks: Walking and gentle daily tasks are encouraged throughout — they support recovery. Because this is a larger and more complex repair, heavy lifting and gym-style work should be avoided for around 8 weeks, sometimes longer. Coughing, constipation, or sudden heavy effort should be controlled where possible — straining tugs at the repair.
• 12 weeks: Gradual return to normal life — driving, light exercise, office work. Guidance on what is appropriate for you specifically is provided at your reviews.
• Seroma: If a fluid pocket forms (common), it is monitored at your reviews. Most resolve without any treatment; if a seroma is causing pain or is very large, a simple aspiration (draining it with a small needle) can be done.
• Long-term follow-up: Further reviews are routinely arranged at 6 months and 1 year to make sure everything is settled and healing well.
• Your first post-operative review is routinely arranged 2–6 weeks after discharge, with timing depending on the type of repair — this review is provided at no charge.
• For day-by-day guidance on wound care, binder use, drain management, and graded return to activity after a major abdominal-wall repair, see the Post-abdominal-wall-reconstruction aftercare guide on the Resources page.

Post-operative concerns: Please call our rooms on (03) 9816 3951 and leave a message — this will be sent directly as a text to Mr Nguyen. Alternatively, you may text the office mobile on 0499 090 126. We aim to respond promptly during business hours.

Emergencies: For any life-threatening emergency, call 000 immediately or go to your nearest emergency department. Do not wait for a call back from our rooms. For the Austin Hospital Emergency Department: (03) 9496 5000.