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When a wound in the abdominal wall does not heal well a hernia can result. This can lead to protuberance of the underlying intestine through the defect, which may be very large indeed. These cases need careful evaluation and may require the input of a team of surgeons consisting of general / abdominal surgeons and plastic surgeons.

Mr Shankar and Mr Floyd, who lead the unit, are now recognised national and international experts in abdominal wall pathology and their partnership of reconstructive and aesthetic surgery leads to both a strong and cosmetically excellent outcome. 

This partnership of reconstructive and aesthetic surgery leads to both a strong and cosmetically excellent outcome.

Abdominal wall reconstruction

If a hernia requires extensive soft tissue management as well as intra abdominal surgery this is then termed an AWR. In order to do this safely and to produce world class results, operations involve both a general and plastic surgeon who operate together on both the abdominal contents, abdominal muscles and the overlying soft tissues.

By aggressively managing the soft tissues, usually with the creation of flaps of tissue, this translates into reconstructing the abdominal wall with healthy tissues. This reduces complications, particularly infection, which is particularly important when dealing with prosthetic mesh implants.

The team has the largest published series in European literature with recurrence rates of less than 5% and a 0% mesh infection rate.

All cases utilise mesh but the type is determined on a case by case basis as per the bespoke service we offer all our patients.

Abdominoplasty (tummy tuck)

Abdominoplasty, or tummy tuck, is a cosmetic surgery procedure that involves the removal of excess skin and fat from the middle and lower abdomen, with a hip to hip scar hidden in the ‘bikini line’. A slimmer waistline and improved body contour results, as well as a firmer abdomen.

During the procedure, and if appropriate, the abdominal wall muscles may be tightened or repaired.

Aesthetic plastic surgery

The fusion of aesthetic plastic surgery with general surgery provides a comprehensive service to our patients, affording a functional and aesthetic repair for all aspects of abdominal wall pathologies from simple groin hernias to major abdominal wall reconstructions / cosmetic procedures.

Abdominal wall tumours

Mr Shankar and Mr Floyd are members of the London Sarcoma Unit and as such manage many complex abdominal wall tumours varying from desmoids to sarcomas. Removing such tumours involves having to achieve an excellent oncological outcome as well as reconstructing the resulting defects in the abdominal wall.

Long term functional recovery necessitates the recreation of the abdominal wall often using intra peritoneal mesh as well as soft tissue reconstruction.

Recurrent incisional hernias

Repair of recurrent incisional hernias ranges from a laparoscopic approach for small defects through to a formal abdominal wall reconstruction. The key is to get the first repair performed by a hernia specialist because the more times the hernia is repaired the less the chance of long term success.

Recurrent cases require careful preoperative planning and usually the larger cases require a AWR for long term success.

Our published outcomes for recurrent hernias are similar to our primary cohort with a recurrence rate of less than 5%.

Keyhole (laparoscopic) and open repair of midline hernias

We offer laparoscopic or keyhole repair of hernias; this surgery is part of our comprehensive, bespoke service. Every hernia is appraised on a case by case basis and if appropriate a 'keyhole approach' is offered.

In keyhole surgery the abdomen is filled with gas and operations are carried out through small incisions which permit the placement of operating ports through which instruments are placed.

Both groin and midline hernias can be repaired using keyhole surgery. In every case, plastic mesh is used. In midline hernias, as in the open cases, we insert a composite plastic mesh using state of the art inflation technology. The inflation device is attached to the mesh and is employed once the mesh is inside the abdomen, allowing the mesh to be accurately placed on the abdominal wall.

The key difference between both types of midline hernia repair is that in laparosocopic cases the mesh is the only component of the repair and simply bridges the defect. In open surgery the mid line defect is closed over the mesh - keyhole cases are only appropriate if the hernia defects are relatively small. Studies indicate that larger hernias are more likely to recur if repaired laparoscopically - in our unit large hernias are always repaired using a technique where our published complication and recurrence rates are exceptionally low.

The mesh technology used is a state of the art expandable device which means minimal fixation is required reducing the risk of nerve injury. Again most of these procedures can be done as day cases and involve 3 small incisions below the umbilicus which are all closed with dissolvable sutures.

Management of infected mesh / complex wound infections

The unit is regularly referred cases with infected mesh in situ. These can be some of our most complex cases and require very careful preoperative evaluation.

In these cases we settle down the soft tissue infections and then usually plan a single stage abdominal wall reconstruction using a biological mesh.

The key step is to recognise that once a plastic mesh becomes infected it nearly always needs to be removed in its entirety which can result in significant damage to the overlying soft tissues.

Also if the mesh is infected this may also affect the underlying bowel which needs very careful management at the same time as the soft tissues.

Post pregnancy abdominal wall

The combination of divarication of the rectus and soft tissue redundancy, often coupled with a midline hernia, requires a surgical solution. This usually involves resecting the redundant soft tissues, reapproximating the midline muscles and repairing any hernia. This may be a mini tummy tuck or an AWR.

Again the combination of general and plastic surgeons provides a robust approach that can manage any abdominal wall or intra abdominal pathology.

Mr Floyd and Mr Shankar provide a post partum abdominal wall service for some of the busiest Obstetric units in London.

Recurrent hernia surgery

A conventional open or non-keyhole approach to repairing recurrent groin hernias involves reopening the old scar and placing a mesh over the defect. This can be done as a day case but may require an overnight stay. The re-do may also apply a different technique, with the mesh placed in a different layer of the abdominal wall but is most often repaired laparoscopically.

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