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Abdominal, Wall Reconstruction.

Source

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018-.
2017 May 22.

Author information

1
New Hanover Regional Medical Center
2
University of Alabama at Birmingham

Excerpt

Abdominal wall reconstruction has become a frequently used term to describe hernia repairs that try to recreate the abdominal wall and restore function and structure. Although there has been no true definition of a functional abdominal wall, many surgeons believe this involves the closure of the fascia at the midline often with reinforcement using mesh prosthetics. The integrity of the abdominal wall is vital as it serves to protect the internal organs, supports the spine and helps maintain an upright posture. Also, the abdominal wall also aids in the performance of several bodily functions that require the generation of Valsalva such as urination, coughing or defecation. There are also suggestions that an absence of an intact abdominal wall can result in the failure to determine satiety, consequently leading to weight gain. Hernia Risks An incisional hernia following exploratory laparotomy occurs in about 5% to 20% of patients. Risk factors for incisional hernia formation include (1) immunosuppression, (2) wound infection, (3) morbid obesity, (4) malnutrition, (5) patient age, (6) prior abdominal surgery, (7) and any medical condition that is associated with an increase in intra-abdominal pressure in the post-operative period. Other biological factors that may increase risk include have a connective tissue disorder like Ehlers-Danlos syndrome, history of the aneurysmal disease, a diet high in chickpeas, or lathyrism. Several tumors can occur on the abdominal wall, and the most common are desmoid tumors. These lesions even though histologically benign, often are very locally invasive. Treatment of desmoids often requires full thickness abdominal wall excision. Despite this, local recurrence rates are nearly 40% to 50%. Most of these recurrences occur within the first 24 months after surgery. In some cases, adjuvant radiation therapy is recommended especially when the margins are not clear. Management of malignant lesions of the abdominal wall requires aggressive resection of the subcutaneous tissues and skin, as well as any involved muscle. Sarcomas are the most common tumors of the abdominal wall and require aggressive resection, followed by radiotherapy. There may also be some intraabdominal wall tumors either via hematogenous or contiguous spread that require resection. Reconstruction of the abdominal wall in these cases is usually directed by the extent of resection and the possibility of further surgical intervention.

Copyright © 2018, StatPearls Publishing LLC.

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