What is AWR?

AWR stands for Abdominal Wall Reconstruction. In this context, Abdominal Wall Reconstruction is typically undertaken for complex Abdominal wall defects resulting from Trauma, Infection, complex Malignancy surgeries, Intestinal Fistulas, failed Hernia repairs or Complex Hernias. This Surgical technique is used for conditions where simple abdominal wall closure or repair of Hernia by open or standard laparoscopic surgery is not sufficient.

The goals of the reconstructive surgeon in managing complex abdominal wall defects are to restore the structural and functional continuity of the musculofascial system and to provide stable and durable wound coverage.

The typical methods used for this are:

In this we are going to mainly focus on repair of complex large Hernias using special techniques to close the midline and repair the hernia with a mesh augmentation

The need for Midline closure:

Laparoscopic IPOM repair gave rise to “Bridging technique”, where a mesh could be put without closing the defect.

This gave rise to problems like more seroma rates, persistent bulge after surgery, prolapsing of the mesh into the defect, pseudo recurrence and sometimes true recurrence.

Loss of midline alignment of Recti and linea Alba gives rise to a significant loss of Abdominal Wall function, causing:

This has brought back the focus on achieving midline closure in all abdominal hernia repairs: the EHS guidelines also recommend closure of midline defect, even using component separation techniques when defects are larger.


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