Abdominal hernias are somewhat misleadingly named, as they actually refer to extensive postoperative deformities of the anterior abdominal wall resulting from previous surgical procedures. Such damage affects not only the skin, muscles, and fascia forming the abdominal wall but also leads to adhesions of the intestines inside the abdomen. Inflammatory processes and postoperative infections further complicate the anatomical picture. Therefore, restoring the shape and function of the intestines and abdominal wall is very complex. In many cases, the corrective surgery for such a defect is much more demanding and complicated than the original procedure (e.g., appendectomy, tumor removal, or abdominal aortic aneurysm surgery).

During the reconstruction of the anterior abdominal wall, the following steps are necessary:

  • The abdominal cavity is opened, and the so-called hernia sac is carefully dissected from the surrounding tissues. Sometimes, these sacs become enormous structures (tens of centimeters in diameter). Inside the sac, there may be adherent loops of intestines and other structures that must also be separated from its wall. This process is called adhesiolysis. Adhesions must be freed not only within the hernia sac but also inside the abdominal cavity, which can be difficult and time-consuming (sometimes taking several hours), involving tissue dissection over an area of about 30x30 centimeters.
  • Only after this stage can the muscles be prepared (mobilized) to be repositioned properly, allowing closure of the hernia defect. The muscles are mobilized across practically the entire anterior abdominal wall — again, an area approximately 30x30 cm.
  • After returning the intestines from the hernia sac back into the abdominal cavity, the peritoneum (a membrane separating the viscera from the muscle layers) must be prepared and closed over the intestines and abdominal cavity contents. This is a very difficult step because the peritoneum is often damaged by previous surgeries or postoperative infections and abscesses.
  • Only then is the space prepared for the implant (mesh) behind the muscles and above the peritoneum. The mesh must be large (sometimes as large as 40x30 cm) so that the margin beyond the hernia defect can transfer the abdominal pressure forces and strengthen the abdominal wall. Without such a properly sized mesh, the entire surgery would be pointless, and the sutured abdomen would rupture again after a few weeks.
  • The procedure concludes with plastic surgery of the skin, removal of old scars, and rearrangement of skin flaps to cover the defects — a reconstructive surgery procedure.

Visualizing this procedure, with a postoperative wound area ranging from 1200 to even 4000 cm², gives an idea of the surgery’s extent and complexity. Patients opting for this surgery should understand it is not a simple "hernia repair." However, the improvement in quality of life after surgery is enormous. Living with a postoperative hernia, with a constant risk of intestinal volvulus and necrosis (leading to abdominal sepsis and possible death), causes great discomfort for every patient.

The complexity of the procedure also explains potential complications. Every surgery is performed with maximum care, but unintended complications may occur. Both our data and global literature describe various complications. Less severe ones include infections, fluid accumulation in the subcutaneous tissue, or partial necrosis of the skin flaps. These affect about 10-12% of patients. Unfortunately, in about 1-2% of cases, respiratory complications such as pneumonia, which are difficult to manage, may occur. Pulmonary embolism incidents are also possible. During bowel dissection, accidental bowel injuries may occur, sometimes requiring segmental bowel resections. Such perforations can also become apparent in the early postoperative days and may require urgent reoperation.

In the past, about 5% of patients undergoing anterior abdominal wall reconstruction died postoperatively. Thanks to advances in knowledge and patient preparation (mainly preoperative weight reduction), this rate has dropped to about 1%. However, a small risk of death remains.

It is important to consider all these aspects and discuss them with your loved ones. We hope that direct conversations with your surgeon will help you make the right decision. Therefore, we always encourage personal visits and discussions with the surgeon.