SURGERY
Improving surgical outcomes in hernia repair
There are significant benefits associated with a multi-disciplinary team approach within the challenging setting of complex abdominal wall reconstruction (AWR). Rachel Harding met with the AWR surgical team at Whiston Hospital to understand all aspects of delivering best practice care for complex hernia patients.
Ultimately, when an abdominal wall reconstruction (AWR) patient leaves the hospital, a surgeon will have hoped to have achieved three things: a strong and resilient abdominal wall, a reduced likelihood of hernia reoccurrence, and a reduction in the risk of the development of surgical site infections (SSI).
Multiple factors are considered ahead of
surgery, as well as best practice for optimum long-term success. How can surgeons minimise the risk of infection when using mesh, as well as keeping down the prospect of reoccurrence?
Evidence shows that the right approach
to AWR will save money, pain, and help a patient back on the road to recovery more quickly. Surgeons and AWR teams need to consider all elements from initial diagnosis through to operation and post-operative care. Getting an operation right first time can save as much as £6,000 to the NHS.1
AWR at Whiston Hospital At the Institute of Abdominal Wall Reconstruction Surgery (TIARS) based in Whiston Hospital, Merseyside, general surgeons work alongside plastic surgeons to decide and deliver the care for complex hernia patients. The plastic surgeons are an integral part of the AWR MDT (multi- disciplinary team), led by Michael Scott who has more than 30 years’ experience,
specialising in colorectal, laparoscopic and abdominal wall reconstruction (hernia) surgery. The AWR team consists of four general surgeons and three plastic surgeons, as well as four anaesthetists, two radiologists, and two theatre teams, with a dedicated administrator. Incorporating the opinions of the MDT and the skills of plastic surgeons, both before surgery and in the operating theatre, means that all the issues around complex hernia repair and excess skin removal are considered at the outset. Potential AWR patients are discussed at the weekly MDT meetings, where they are carefully assessed, and individual treatment plans are created. This takes into account an extensive patient history, looking at
At Whiston, the MDT approach means that surgeons and plastic surgeons work in pairs. The plastic surgeons and the general surgeons work together on every single operation in both pre-planning and in the surgery itself.
AUGUST 2021
comorbidities and anything which could add to, or create, medical complications. Pre-operative work for a patient can include losing weight or stopping smoking, before an operation can go ahead, but the urgency of a case will be kept in mind. Every operation is jointly performed by two consultant surgeons – one general and one plastic working as a team. Both surgeons are present for the entire operation and both specialties look after the patients post-operatively. An AWR patient plays an equal role in their surgery and recovery. Good compliance must be followed both beforehand and afterwards. Smoking cessation and appropriate dietary care will play a part in the increase of a full recovery. Smoking can cause an increase in wound healing time, and studies have found a reduced risk of SSI in those patients who ceased smoking four weeks before and after an operation.2-4
Understanding the surgery and the anatomy (skin and subcutaneous tissue)
An abdominal wall hernia can be small and simple, or large and complex (considered to
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