Abdominal wall reconstruction

Hernia is the general term used to describe the phenomena when an organ or other bodily structure protrudes through the wall that normally contains it.  This is most frequently applied to the herniation of abdominal organs (most likely the small intestines) through the abdominal fascia.  This event can occur in a variety of locations within the abdominal wall for a multitude of different reasons.  A typical inguinal hernia describes the protrusion of small bowel through fascia in the groin and is most typically managed by a general surgeon.  A ventral hernia, on the other hand, involves the protrusion of organ tissue through the midline of the abdominal wall.  Depending on the severity of the herniation a general surgeon may choose to work with a plastic surgeon to reconstruct the defect responsible for the hernia.

Certain patients with a midline abdominal hernia may benefit greatly by the release of their rectus abdominis muscles (the muscles responsible for a 6-pack) from their side attachments to allow them to be shifted to the middle.  This procedure known as a ‘components separation’ aims to restore the natural anatomy that has been obliterated as a result of the hernia.  When combined with the placement of a mesh this technique provides a reliable long term solution to this oftentimes debilitating condition.  Plastic surgeons are uniquely well suited to performing this procedure, as their expertise is in the movement of bodily tissues, especially muscle, to treat a wide variety of possible defects.

Patients with excess skin and fat who suffer from a midline abdominal hernia may also benefit from the removal of this excess tissue at the time of hernia repair.   This procedure, known as a panniculectomy, is a powerful tool for eliminating excess abdominal tissue beneath, and to a limited extent above, the belly button.  The combination of hernia repair and panniculectomy is performed to limit pull and stretch on the sutures responsible for hernia correction. Ideal candidates for this surgery are those with midline hernias who also have excess abdominal skin and fat especially below the belly button. 

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