Abdominal Wall Reconstruction

Overview

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 Mr Nguyen uses is called a component separation — specifically, a posterior component separation using a procedure called transversus abdominis release (TAR). In plain terms, this means he carefully releases one of the deeper muscle layers on each side of your abdomen, 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. Mr Nguyen performs this both as an open operation and using the robotic technique, which uses small incisions and a magnified 3D view.

Who needs this procedure?

• 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

Benefits

• 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 strongest possible position (behind the muscle), giving a very low chance of the hernia returning even for complex cases
• When done robotically, Mr Nguyen uses small cuts rather than a large open incision — 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
• Patients often notice a significant improvement in their comfort, strength, body shape, and ability to do everyday activities
• For people who have already been through one or more failed repairs, this is often the most definitive option available

Risks & considerations

This is a more involved operation than a standard hernia repair, and Mr Nguyen believes 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. Mr Nguyen will discuss your personal wound risk before surgery.
• Seroma (fluid collecting under the skin) — this is very 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 significant 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 — 5–15% over five years even for complex cases. This is much lower than many comparable techniques, but worth knowing about.
• 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.

Before the procedure

• A CT scan with 3D reconstruction — this gives Mr Nguyen a detailed map of your abdominal wall so he can plan the operation 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. Mr Nguyen's 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

On the day

• You will be under a general anaesthetic — 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 — Mr Nguyen releases the deeper muscle layer 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 strongest and most durable location for the mesh.
• 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.

Recovery & aftercare

• 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 — Mr Nguyen will check healing and remove any remaining sutures 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.
• 8 weeks: You can start returning to light activities such as short walks and gentle daily tasks. No heavy lifting yet.
• 12 weeks: Gradual return to normal life — driving, light exercise, office work. Mr Nguyen will guide you on what is appropriate for you specifically.
• Seroma: If a fluid pocket forms (very common), Mr Nguyen will monitor it 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: Mr Nguyen will want to see you at 6 months and 1 year to make sure everything is settled and healing well.
• Your first follow-up after discharge is arranged within 2–6 weeks (timing depends on the type of repair). This visit is provided at no charge.

Related patient guides

We have written plain-language articles to help you and your family understand what is happening and feel more prepared — at every stage from diagnosis through to recovery.