Abdominal wall hernias are best reconstructed by recreating a functional abdominal wall. That is, return all the abdominal wall musculature back to its original position. When patients cough, sneeze, or bear down to have a bowel movement, this increases the intra-abdominal pressure. As the intraabdominal pressure increases, the abdominal wall musculature exerts a back pressure on the viscera. If there is a segment of abdominal wall that is devoid of functional (i.e. contracting muscle) then hernias tend to occur, or can occur in areas of weakness.
Often the hernias can be repaired with an underlay of structure with transfascial sutures and with restoring the abdominal wall musculature over the structure. That is when the abdominal domain is composed of functional muscle, there is a decreased chance of the hernia recurring.
Large hernia surgery typically requires an inpatient stay of three to seven days. During that time we are waiting for bowel function to resume, ambulation to occur, and pain to be controlled on oral pain medications.
An abdominal binder is worn in placed for 8 weeks. after eight weeks patients begin physical therapy to increase core musculature without large ranges of motion (i.e. no crunches or abdominal extension). Once the ore muscle strength is restablished, then patients begin to resume normal activity.
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