BHSeP9 Complex abdominal wall hernia: our experience in a DGH

Incisional hernias are a common complication and can be very challenging to manage. The incidence is about 20–25% after a major operation. We present our experience of Complex Abdominal Wall Reconstruction (CAWR) at a District General hospital (DGH).

Methods

The team comprises 2 Upper GI surgeons, anaesthetists who help optimise the high-risk patients and a radiologist. All patients are initially discussed in the CAWR MDT that takes place weekly. The CT scans are reviewed with the radiologist.

Results

Data from 24 patients was analysed from 2021 to 2024. The mean age of the patients was 59 (44–77) years and the average BMI was 32 (28–46). All patients had a pre-op CT scan to delineate the anatomy and were discussed in the MDT. Open Rives-Stoppa repair was performed in 20 patients (83.3%), Transversus abdominus release in 3 (12.5%) and component separation in 1 patient (4.1%). 22 patients (91.6%) had a planned elective operation whereas 2 (8.3%) underwent emergency repair due to bowel obstruction. Prolene mesh was used in 20 patients (83.3%), 3 (12.5%) had Phasix mesh and 1 (4.1%) had Permacol mesh. 1 patient (4.1%) developed a mesh infection requiring re-operation and excision of mesh, 2 patients (8.3%) had superficial wound infection that was treated with antibiotics and respiratory complications were seen in 2 (8.3%) patients.

Conclusion

Our experience and outcomes indicate that CAWR is feasible at a DGH with a dedicated team. The follow-up shows good outcomes with only one recurrence so far. Patients report a better quality of life.