The abdominal wall represents a very unique construct in human anatomy. Consisting of a series of overlapping muscles and tendons, the abdominal wall provides both static (standing still) and dynamic (in movement) strength to the human body. Athletes, athletic trainers and physical therapists commonly refer to this area as “the core”. Many patients and athletes attest that injury or damage to “the core” can result in disharmony of muscle interplay, leading to back pain, discomfort or imbalance. Medically, the abdominal core provides enough stability to support the intestines (for digestion), while still allowing flexibility and compliance to assist with breathing.
Abdominal Wall Defects and Hernias
Many patients with a variety of intestinal, solid organ, and gynecologic problems require abdominal surgery. While many of these operations can be performed laparoscopically (i.e. utilizing a small camera and small incisions), larger surgeries often require an incision called a laparatomy. This incision can sometimes disrupt normal muscle and tendon attachments to the abdominal wall, leading to an incisional hernia. Some studies suggest up to 1 out of every 10 patients who undergo abdominal surgery experience this complication.
Once a hernia occurs, it can worsen. Large hernias can lead to significant stress on the spine and back pain, which can be debilitating and make exercise or carrying out the activities of daily living challenging. Hernias can also expand, leading to worsening symptoms. In some cases, hernias can cause the intestines to twist, leading to bowel obstructions that constitute a serious surgical emergency.
Often, when patients require abdominal surgery in the setting of severe infection or trauma, the normal architecture of the abdomen is vastly distorted, which makes closing the skin surgically impossible. These types of wounds are often healed by a method that leaves significant scarring, deformity or instability of the abdominal skin. This often leads to leakage of intestinal contents directly through the front of the abdomen. The condition (known as enterocutaneous fistula) can be exceptionally challenging to treat, often requiring months of bowel rest, intravenous nutrition and multiple operations.
– Former surgery patient
Traditional Methods of Hernia Repair
Surgeons commonly use a prosthetic mesh repair technique to repair hernias. Although this is often very successful for small hernias, in many cases with larger hernias, studies have shown very high recurrence and complication rates. Some studies place the documented rate of recurrence after such repairs of large hernias using prosthetic mesh at over 24 percent for first-time repairs, with second or third attempts higher than 35 percent. While prosthetic mesh repairs do create a barrier to “plug” the hernia, they do little to restore the normal architecture of the abdomen and restore function.
Abdominal Wall Repair Using Biologic Mesh
Dr. Pacella’s philosophy of hernia repair revolves around the concept that restoration of the natural anatomic connections of the abdominal wall is critical to long-term success. Utilizing the abdominal component separation technique, repair of the hernia is achieved by releasing scar tissue to restore the natural midline attachments of the abdominal wall. The position of these muscles is reinforced internally with a “biologic mesh” (also called an acellular dermal matrix) made of animal tissue that is ultimately incorporated into the body. Because no synthetic material is used in this surgical technique, the risk of infection is minimized. Benefits of this technique include utilizing the patient’s natural tissue with very good blood supply and restoration of strength and flexibility with exceptionally low rates of hernia recurrence.
A Team Approach at a World Class Institution
Dr. Pacella has developed a team approach to treating complex hernias. Together with a team of anesthesiologists, general surgeons and physicians, Dr. Pacella utilizes the latest techniques in reconstructive surgery to restore the abdominal wall. The surgery often requires a hospital stay and recovery may require months of physical therapy. Surgeries are performed through two world class hospitals affiliated with Scripps Health: Scripps Green Hospital and Scripps Memorial Hospital La Jolla. Recognized as a reconstructive surgeon with a specialized interest in abdominal wall reconstruction, Dr. Pacella was recently interviewed for the San Diego Union Tribune: