Abdominal Wall Reconstruction
What is abdominal wall reconstruction surgery?
Abdominal wall reconstruction is the practice of taking a dysfunctional abdominal wall due to hernia disease and putting it back together using advanced surgical techniques. Abdominal wall reconstruction is reserved for large, more complex, or recurrent hernias.
The abdominal wall
The abdominal wall is one of the most complex anatomic structures in the human body. Its interconnected muscles work together to support movement and protect the abdominal organs.
The major muscles that we may attempt to reconstruct are the:
Rectus abdominis
External oblique
Internal oblique
Transversus abdominis
Why reconstruction?
Due to the complexity of certain hernias, repairing them with simple sutures may not be enough. In certain cases, a reconstructive procedure called a component separation may be necessary. This involves releasing selected abdominal wall layers to help bring the tissues together and close the hernia. Your surgeon will explain the technique, its expected benefits, and its potential effects on abdominal wall function.
How is abdominal wall surgery performed?
Abdominal wall surgery may be performed using:
An open technique with traditional incisions
Laparoscopic technique using small incisions
Robotic technique using small incisions
Small incisions are generally preferred, but there are often reasons that make an open approach better, such as the difficulty in closing incisions, or the need to remove redundant tissue or skin.
There are several surgical procedures that fall under the category of reconstruction. These include:
Retro-rectus Rives Stoppa repair
This involves cutting the connective tissue, or fascia, around the rectus (ab) muscles to flatten them and bring them together.
This technique attempts to re-approximate your rectus abdominis muscles and repair the hernia at the same time. Mesh is placed behind your ab muscles.
Anterior component separation
This procedure releases the external oblique layer to help bring the abdominal wall together with less tension. Your surgeon will discuss the expected effect on core function and recovery.
With this approach, mesh is placed between the skin of the abdominal wall and the ab muscles.
Posterior component separation, or Transversus Abdominis Release (TAR)
This involves cutting the transversus abdominis muscle, the innermost of our oblique muscles.
This surgery is more complex than the Rives-Stoppa techniques, in that to assist with closing large hernia defects, a cut is made in one of your oblique muscles (the transversus abdominis) so that your hernia can be repaired without tension. Your surgeon will discuss the expected effect on core function and recovery.
Mesh is placed between the lining of the abdominal wall and the ab muscles.
Mesh and abdominal wall reconstruction
Mesh is often used to reinforce an abdominal wall reconstruction and reduce the chance of the hernia returning. Permanent and other mesh options have different benefits and risks. Your surgeon will explain which material and placement are appropriate for your case.
Synthetic and biologic mesh can have complications, including infection, erosion, and persistent pain. When appropriate, we place mesh within abdominal wall layers to separate it from the bowel and use techniques intended to protect nearby nerves. The plan depends on your anatomy and previous operations.
Recovery after abdominal wall reconstruction
Your recovery plan depends on the repair, your health, and the complexity of your case. Your surgeon’s discharge instructions take priority over general guidance on this page.
Immediately after surgery
You will recover in the Post-Anesthesia Care Unit (PACU), where the team monitors you as the anesthesia wears off. Some patients go home after recovery; others need a hospital stay, particularly after complex abdominal wall reconstruction. Your team will decide when discharge is appropriate.
Temporary shoulder or upper abdominal discomfort can occur after laparoscopic or robotic surgery because of the gas used during the procedure. A sore throat can follow a breathing tube or gastric tube. Tell your team about persistent or worsening symptoms, including difficulty swallowing.
Chest pain, shortness of breath, fainting, or sudden weakness require immediate medical attention. Alert hospital staff immediately; if you are at home, call 911.
During a hospital stay
Your team will help you begin walking and moving safely. Follow their instructions for how often to get up and whether you need assistance.
You may receive an incentive spirometer, a handheld device for deep-breathing exercises. Use it as instructed.
Your pain-management plan may include nonopioid medicines, opioid medicines when needed, or patient-controlled analgesia (PCA), which allows you to press a button for a controlled dose. Medicines may be given through an IV and later by mouth.
Your team may provide medicine to prevent blood clots, such as heparin or enoxaparin (Lovenox), and medicine for nausea. They will also review which home medicines to resume.
Preparing to go home
You will receive prescriptions, follow-up arrangements, and instructions for wound care, diet, medicines, and activity. Arrange a ride home and help during recovery. Remove loose rugs and cords that could cause a fall.
Ask your team before combining pain medicines with sleep aids, sedating antihistamines, anxiety medicines, or muscle relaxants. These include diphenhydramine (Benadryl), clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), cyclobenzaprine (Flexeril), and carisoprodol (Soma).
Recovering at home
Follow your team’s instructions for fluids, food, walking, and bowel care. Your needs may differ depending on other health conditions and the operation. Contact your team about fever or chills, persistent nausea or vomiting, difficulty passing stool, or symptoms that are getting worse.
Return to work, lifting, exercise, driving, and travel should follow your surgeon’s guidance. Increase activity gradually within those instructions. A larger, recurrent, or more complex repair may require a longer recovery.
Follow-up
Attend follow-up as directed so your surgeon can assess healing and adjust your activity plan. Recovery continues after you begin feeling better. If activity causes renewed discomfort, reduce the activity and contact your team if symptoms persist or worsen.
Possible complications and when to seek help
Possible complications include pneumonia, atelectasis (partial lung collapse), wound infection or separation, abscess, urinary infection or difficulty urinating, bowel injury, blood clots, bleeding, persistent pain, hernia recurrence, and the need for additional surgery. Your surgeon will discuss your individual risks.
A seroma can feel like a lump where the hernia used to be, particularly after a larger repair. Some resolve without treatment, but your team should assess a new or concerning swelling. Some bruising around the incisions or groin can occur after surgery.
When to call your surgical team
Follow the contact instructions in your discharge paperwork. Call for:
Fever of 100.4°F or higher, or fever as defined in your discharge instructions.
Increasing redness, wound opening, or drainage from an incision.
Bleeding that does not stop with pressure as instructed.
Persistent nausea or vomiting.
Difficulty or inability to urinate after surgery.
Severe or increasing abdominal pain, including pain not relieved by prescribed medication.
Extensive or increasing bruising, swelling, or discoloration.
Symptoms that are getting worse rather than improving, or any concern about your recovery.
When to seek emergency care
Call 911 for chest pain, fainting, shortness of breath or difficulty breathing, trouble speaking, new weakness, sudden vision changes, or uncontrolled bleeding. Notify your surgeon after emergency care has been arranged.
Tips for a successful recovery
from abdominal wall surgery
Here are some useful tips you can use to make sure your recovery from hernia surgery goes as smoothly as possible, including information on diet, drain care, activity, pain management and more.
Diet, incision care, and drains
Eating and drinking
Follow your discharge diet and fluid instructions. If your team recommends a light, soft diet, options may include soups, broths, gelatin, yogurt, cottage cheese, pudding, and scrambled eggs. Ask when to advance your diet and whether protein supplements would be useful.
Incision care
Keep incisions clean and dry and replace wet dressings as instructed. Your team will tell you when to shower and how to care for surgical glue or Steri-Strips. Let water run gently over the area, pat dry, and avoid scrubbing or picking at the closure. Do not apply ointments or soak in a bath, pool, or hot tub until your surgeon approves.
Contact your team about increasing redness, swelling, pain, discoloration, or drainage.
Abdominal binder
If you receive a binder, follow your surgeon’s instructions for when and how long to wear it. Follow the product’s washing instructions. Additional binders may be available at pharmacies or online.
Drain care
A drain may be secured to your skin with a stitch. Use the securing method taught by your team to prevent hanging or pulling; do not use safety pins on the tubing.
Empty the drain and record the amount and appearance of fluid on the schedule your team provides. Use the supplied log or a separate sheet. Drainage may change from bloody to pink or clear yellow during recovery, but changes should be assessed in the context of your instructions and symptoms.
Only strip or clear tubing if your team has shown you how. Wash your hands and avoid pulling on the drain. If it stops draining, leaks, becomes dislodged, or falls out, contact your surgical team for guidance. Keep the surrounding skin clean and dry as instructed. Seek urgent care if you also have severe symptoms.
Drain removal depends on your healing and drainage output. Bring your log to follow-up and ask about pain relief and transportation for that appointment.
Activity and symptom management
Movement and exercise
Begin walking and using stairs with assistance as directed. Follow your team’s breathing exercises and gradually increase everyday movement within your restrictions.
Your surgeon will set lifting limits and advise when to resume work, jogging, exercise, golf, swimming, and other sports. Timing depends on your repair, healing, and case complexity. Stop and rest if activity causes pain; contact your team if symptoms persist or worsen.
Pain management
Follow your prescribed plan for acetaminophen (Tylenol), ibuprofen, or other medicines. Doses and suitability depend on your health and other medications. Opioids may be needed in some cases; ask your team how to reduce them as recovery progresses. Use ice or other comfort measures only as instructed.
Your abdominal muscles are recovering, and back discomfort can also occur. Ask your team about appropriate measures if this is troublesome.
Bowel care
Follow your discharge plan for fluids, food, walking, and any stool softener or laxative. Options such as docusate (Colace), polyethylene glycol (MiraLAX), senna, milk of magnesia, mineral oil, or dietary measures should be discussed with your team rather than combined without guidance. Avoid straining.
Contact your team if bowel function is not returning as expected. Inability to pass gas with nausea, vomiting, or increasing abdominal swelling needs prompt medical assessment.
Cough
Contact your surgical team or primary care clinician about a persistent cough so it can be assessed and treated appropriately.
Plan your return to daily life
Discuss these topics with your surgeon before discharge:
Driving: Do not drive while taking opioid pain medicine or while pain or limited movement affects safe driving. Ask when it is appropriate to resume.
Travel: Discuss flights and longer trips in advance, including follow-up needs.
Work: Your return depends on the demands of your job, the operation, and your progress.
Tobacco, cannabis, and alcohol: Ask your team about stopping and when, if ever, to resume. Discuss interactions with pain medicines and other prescriptions.
Nutrition: Ask whether a protein supplement fits your recovery plan and any dietary restrictions.
These decisions are individualized. Follow your surgeon’s specific instructions rather than a general timetable.
Next Steps
The Columbia Hernia Center offers individualized care for complex hernias and abdominal wall reconstruction. We use enhanced recovery protocols and preparation before surgery, sometimes called prehabilitation, tailored to your needs.
Your surgeon will discuss the repair technique, mesh options and placement, expected hospital stay, pain management, and recovery plan. We focus on careful surgical technique, ongoing review of our outcomes, and nonopioid pain control when appropriate.
Our surgeons and office staff will support you through preparation and follow-up, monitor your progress, and answer your questions.
To schedule a consultation, call (212) 305-5947 or use our online appointment request form.