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Conditions

Our leading private surgeons offer patients expertise in treating the following abdominal conditions:

Abdominal wall hernias of all types

An abdominal hernia is a swelling or bulge that occurs when part of your abdomen, like your intestine, pushes through a weakness in the muscle of your abdominal wall. The abdominal wall runs between your ribs and your groin; it’s a sheet of tough muscles and tendons that acts like a natural corset, to hold all the abdominal organs in place.

The most common types of abdominal hernia are:

  • Inguinal hernia. This is when a bulge appears in your groin or, if you're a man, in your scrotum. Inguinal hernias are more common in men
  • Femoral hernia. This bulge also appears in your groin. Women are more likely to have a femoral hernia than men.
  • Incisional hernia. A bulge appears near an old surgical scar, usually as a result of a weakness in the muscles which was caused by earlier surgery. An incisional hernia can occur years after surgery and is more common in adults.
  • Umbilical hernia. A bulge appears around the belly button because of a weakness in the muscle layer in or around it. These types of hernias are very common in young children but often disappear as they get older. In adults, they are most common in women during and after pregnancy, and in people who are overweight.
Abdominal wall tumours

An abdominal tumor is an irregular mass of abnormal cells in the middle of the body, usually in the stomach, abdominal wall or the intestines. They can be either benign (usually slow growing and harmless); malignant (cancerous) or pre-malignant (could turn into cancer). The causes, symptoms, and treatment for these growths can vary greatly, but cancers related to this area often have a poorer prognosis than many other types.

Mr Shankar and Mr Floyd, who lead the unit, are recognised national and international experts in abdominal wall pathology and run a complex service, with referral pathways into the London Sarcoma Service where necessary.

Complex incisional hernias

After surgery on the abdomen the incisions can create sites of potential weakness which may then develop into “incisional hernias”. Incisional hernias are more common with increasing age, obesity, after emergency surgery, the type of incision and particularly if there was a post operative wound infection.

Once a hernia forms, its management can be complicated and involves repairing the defect with a prosthetic mesh, dealing with the underlying bowel and optimally managing the overlying soft tissues.

Our unit has the widest experience of complex hernias in the UK and has operated on some of the most complicated cases. Our outcomes have been widely published in international literature.

Fistulas

After complex abdominal surgery, the bowel may sometimes be injured or not heal as intended. This can lead to the catastrophic complication of fistula formation where the bowel communicates with the skin.

The team accepts these patients from across the UK and overseas; our MDT members work within the intestinal failure service at UCH.

Once a fistula develops the patient will then need intensive work up prior to a definitive operation to restore the continuity of the gastrointestinal tract which usually involves reconstructing the abdominal wall.

Groin hernias

These are the most common types of hernia and can present at any time of life, although they are more common with increasing age. Classically they present as a lump in the “groin” which may be painful. Once the hernia has occurred, it should be assessed by a suitably qualified doctor and the majority will require a surgical repair.

There are two types of groin hernia:

  • Inguinal hernias occur in the inguinal canal, which is a tunnel passing through the muscles in the groin. They appear as a lump just above and to the side of the pubic bone.
  • A femoral hernia passes down the femoral canal and usually appears as a lump just below and to the side of the pubic bone.

The inguinal hernia is the most common type of groin hernia; it is more common in men than women due to the passage of the structures supplying and draining out of each testicle and which pass through all the layers of the groin muscles. This creates an area of potential weakness through which the hernia may form.

A femoral hernia is less common but occurs more often in women and is usually found lower in the groin than in the inguinal variety.

Infected mesh

Since all abdominal wall hernia repair requires the use of prosthetic mesh one of the sad complications of such operations is that the mesh may become infected.

Once this occurs, the patient is then committed to further operations to remove the mesh and reconstruct the abdominal wall. The team accepts referrals from across the UK and worldwide with mesh infection - once an infection has occurred the best outcomes are achieved in specialist units and, with careful specialist planning, most cases can be managed by a single operative procedure.

The first step is to deal with any ongoing infection, image the abdomen and drain any collections. All cases then undergo careful assessment by the team including microbiologists.  The patients are then optimised and planned for definitive surgery.

Radical debridement of all unhealthy tissue, removal of the mesh and utilisation of a biological mesh instead is coupled with soft tissue reconstruction.  In the team’s experience this has resulted in a 0% post operative mesh infection rate.

These are some of the most complex cases and early referral to a specialist unit translates into improved outcomes.

Midline hernias (including umbilical, epigastric and periumbilical hernias)

Midline hernias may affect anyone at any stage of their life and usually require a repair to avoid strangulation. Most of these hernias can be repaired when the patient comes into hospital as a day case, using mesh reinforcement (without mesh recurrence rates are far higher).

The new generation of prosthetic meshes are placed behind the defect and can sit safely on the intestine underneath and provide a mechanically sound repair.

The mesh can be placed using an ‘open’ conventional technique or via laparoscopic (‘key hole surgery’) approach but the principles are the same in terms of where the mesh is positioned.

Sometimes the hernias are associated with soft tissue over hang and a splitting of the rectus muscles in the midline and in these cases repair of the hernia maybe combined with a plastic surgical reconstruction. This is particularly common in women after child birth and is important in both the effectiveness of the repair and in the cosmetic appearance.

Post child birth abdominal wall

After child birth the abdominal wall may be left with ongoing soft tissue changes that do not respond to exercise and core stability training. In many cases the muscles split apart leaving a large defect in the midline – a so called ‘divarication of the rectii’. This is often coupled with soft tissue redundancy and, in many cases, a midline hernia.

Once these changes occur only an abdominal wall reconstruction can restore the normal anatomy and hence provide the patient with core stability.

Operative interventions vary from a ‘mini tuck’ to a full ‘abdominal wall reconstruction’ utilising mesh.

Recurrent incisional hernias

The data clearly shows that the best chance of a long term success when repairing incisional hernias is at the first repair. The greater the number of repairs the patient has translates into worsening outcomes and hence the importance of involving a specialist team at the start. The data suggests a recurrence rate of 20-40% in non specialist units.

The more frequently an abdominal wall is operated upon, the more damaged the soft tissues become thus making the intra abdominal compartment more difficult to manage.

The team receives patients from across the UK and worldwide who have undergone previous repairs that have failed and these can be some of our most complex cases.

Stomal hernias

After a stoma has been created, whether for faecal or urinary diversion, the surrounding tissues may become weakened. This can translate into a variety of types of incisional/stomal hernias.

The team comprises hernia, colorectal and urological surgeons so we are able to deal with even the most complex stomal hernias.

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