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Complex Ventral Hernia Repair: Advanced Solutions for Abdominal Wall Hernias
Complex Ventral Hernia Repair: Advanced Solutions for Abdominal Wall Hernias

Complex hernias are typically the types of hernias that are difficult to repair compared to standard ventral hernias. They occur when tissues or organs, such as the ovaries, spleen, or appendix, protrude through the abdominal wall. Some of the characteristics making complex ventral hernia repair challenging are:

    • Large size – Complex ventral hernias are typically larger (7cm), which takes a significant portion of the abdominal wall, making it difficult to repair as it requires a larger bariatric procedure.
    • Multiple hernias – Developing more than one hernia at the same time makes it hard for a bariatric surgeon to close the ventral hernia
    • Location – It’s more complicated to repair a hernia in the upper abdomen or belly bottom than those in the lower abdomen.
    • Past hernia repairs – Complex ventral hernias are more likely to come back if you have undergone hernia surgery in the past, making it more complicated for a new hernia to be closed. The risk of a hernia coming back can be due to past failed repairs, underlying medical conditions, infections, or patient-specific factors.
    • Multidisciplinary approach – It’s not easy to manage complex ventral hernias because of their complexity and as a result, it often requires multidisciplinary methods, including surgeons, anesthesiologists, or other specialists such as wound care experts to ensure comprehensive examination, treatment planning, and aftercare tailored to specific individual patient’s needs.

In other words, complex ventral hernias are associated with a higher risk of recurrence, larger size, compromised surrounding tissue, underlying medical conditions, increased risks of complications such as bowel obstruction, trapped or choked intestines, and the need for a comprehensive approach for effective repair.

What Causes Complex Ventral Hernias?

A complex ventral hernia can be caused by:

        • Obesity
        • Congenital defect
        • Aging
        • Cancer
        • Anaemia
        • Chronic obstructive pulmonary disease (COPD)
        • Several hernia surgeries
        • Poor hernia repair
        • Smoking
        • Wound infection
        • Excessive abdominal pressure after surgery
        • Thinning or weakening of the past surgery area
        • Excessive corticosteroid use

 

Challenges Involved in Repairing Complex Ventral Hernias

Repairing complex ventral hernias presents several difficulties due to their size, location, related complications, and patient-specific factors. Here are a few key challenges involved:

  • Post-operative complications: Since these procedures are complex, they often carry a higher risk of complications, including mesh infections, chronic obstructive pulmonary disease (COPD), prior surgical site infections, seroma, and chronic pain.
  • Recurrence: Despite advancements in hernia surgical procedures, the rate of complex ventral hernia reappearing can still be higher, ranging from 25% to 50% after previous repairs. However, the recurrence rate varies depending on the repair type. For instance, open-mesh repairs are 13% to 15%, laparoscopic repairs with mesh are around 10% to 12%, and open-tissue repairs are 18% to 20%.
  • Component separation: Complex ventral hernias may include the separation of muscular layers of the abdomen, and reattaching these layers and restoring proper functions add complexity to the surgery.
  • Mesh placement: Surgeons often use synthetic mesh to reinforce the repair of ventral hernias. In complicated cases, usually the ones with infection, mesh placement becomes risky since it can increase infection rates.
  • Large size: Complex ventral hernias often involve a significant portion of the abdominal wall, making the surgical repair more challenging. The larger size may require extensive dissection, reconstruction of the abdominal wall, and the use of mesh or other reinforcement materials to achieve a durable repair.
  • Tissue Selection: Large hernias often stretch the surrounding abdominal wall tissues making it difficult to suture the stretched tissues for closure. Therefore, choosing the right tissue quality can be challenging due to factors such as infections, previous surgeries or chronic conditions like diabetes or obesity. Moreover, poor tissue quality can affect the success rate of hernia repair and increase the risk of complications such as wound infections or mesh complications.
  • Risk of related complications: Complex ventral hernias may be associated with complications such as bowel incarceration or strangulation. Repairing these hernias presents a unique challenge since it requires a specialized intervention to prevent further complications like bowel obstruction or tissue necrosis.
  • It requires a multidisciplinary approach: Managing complex hernia can be challenging, and that is why it requires an inter-professional team such as surgeons, wound specialists, and anesthesiologists, which can be difficult to coordinate.

 

Complex Ventral Hernia Repair By Dr. Garcia

In the past, complex ventral hernias were considered difficult to repair due to their recurrence more than once, complications that may occur from poor surgeries or loss of abdominal integrity. As a result, patients were discouraged from having surgeries, which posed a unique challenge that required a specialized hernia surgeon. Dr. Alvaro Garcia has performed complex abdominal wall repairs that seemed unfixable in the past. Dr. Garcia has incorporated robotic surgery in creating muscle flaps with very small incisions.

However, Dr. Alvaro Garcia has transitioned to hybrid techniques that blend open, laparoscopic, and robotic approaches to repair complex ventral hernias. With the new robotic technique for complex hernia, patients are experiencing quick recovery since the bariatric procedure can be performed in an outpatient setting, which means the complication rates from large wounds or seromas have drastically disappeared.

Because of the complexity of the patient’s adhesions or mesh from previous bariatric procedures and weakened abdominal wall tissues, the complex hernias repair must be substantially strengthened, typically with biological mesh. This is the creation of flaps of muscle and aponeurotic to allow the midline to be fixed together. Therefore, the first hernia repair is important to prevent incisional hernias from reappearing, and choosing the right surgeon is your first step in achieving the best possible results.

Book an Appointment Today in South Florida

If you’re looking for a hernia repair surgeon in South Florida, book an appointment with Dr. Alvaro Garcia. Doctor Garcia has managed to repair complex ventral hernias that were formerly thought difficult to fix. Dr. Alvaro uses a combination of the latest technology and cutting-edge procedures, such as open and robotic surgery techniques, to close hernia. Additionally, this bariatric hernia surgery can be performed in an outpatient setting, which minimizes complication rates from seromas and large wounds. Call us today to schedule a consultation.

Dr. Garcia is a robotic gastric sleeve surgery specialist located in Pembroke Pines in South Florida. Robotic Gastric Sleeve Surgery is performed using the Davinci X-i. Contact our offices today for a consultation.

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Tuesday : 9AM - 5PM
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Friday : 9AM - 5PM
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