AWR SURGERY

Abdominal wall reconstruction (AWR) surgery is a subspecialty of general surgery that repairs or replaces a weakened abdominal wall. It is often used to treat hernias.

Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains How AWR surgery is performed.  

How AWR surgery is performed  

AWR surgery can be performed using laparoscopic, robotic-assisted, or open methods.

Who are the right patient for AWR Hernia Surgery?

Those patients who have intermittent discomfort, and inability to perform certain activities of daily living due to a large hernia. In these patients, the surgeon has the opportunity to optimize comorbidities preoperatively. The ultimate goal is the improvement of the patient’s quality of life. The means for obtaining this goal are 2-fold: the surgeon must achieve a strong, durable dynamic abdominal wall, which is usually best obtained by mesh-reinforced innervated musculofascial reapproximation. The surgeon must also strive to minimize complications such as hernia recurrence and surgical site occurrences.

Dr. Ashish Vashistha, BEST HERNIA SURGEON IN DELHI Explains How to take a call to decide on AWR surgery.

How to take a call to deciding on AWR surgery  

• There should not be any co- morbidities or contamination.
• Preferably Diabetes and respiratory conditions should be under control.
  
• Try to shed weight before surgery if possible
• Immune suppression should be minimal.

 Select the correct procedure

• We should minimize the risk of hernia recurrence and bulge.
• Primary musculofascial closure should be good.
• Most closures in complex patients should be reinforced with mesh.

We should make fascial closure after adequate debridement of non-viable damaged tissue. This will help us have a dynamic abdominal wall that can resist stress and stain, helping us have lower rates of hernia recurrence. If, for any reason, primary closure cannot be achieved, then component separation should be tried.

The issue of tension on closure deserves special attention. Excessive tension can cause fascial dehiscence and hernia recurrence.

Excessive tension can Cause abdominal compartment syndrome. This can be fatal. 

Ensure proper mesh placement and fixation.

Ideally mesh location should insulate the viscera from the mesh. The retro-ectus / retro muscular plane (rives -stupa)  technique is very good.

Another mesh placement is the intraperitoneal under-lay position.

-Choosing the correct mesh 

While deciding about the type of mesh, the surgeon needs to weigh each patient’s risk of infection against recurrence – 

Meshare of two types –

-Synthetic

-Biologic

Synthetic meshes are more durable-

Biology meshes tend to be more resistant to infection.

Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains that what are the key indications for AWR Suregry. 

What are the key indications for AWR  surgery?

·       Large or complex abdominal; wall hernia

·       Recurrent hernia

·       Serve abdominal wall weakness

·       Large abdominal wall defects

·       Symptoms imparting quality of life