The complex abdomen
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Background: Recurrent ventral incisional hernia in patients considered candidates for abdominal wall reconstruction techniques is never an isolated event. These individuals frequently have complex intraabdominal as well as psychological, nutrition, and physical limitations which must be addressed for successful outcome.
Methods: A "Complex Abdomen” team was formed to meet the varying needs of patients requiring reconstruction for recurrent ventral incisional
hernia after multiple abdominal operations. At the heart of the team is a coordinator or navigator who arranges independent evaluation by a senior general surgeon, critical care specialist, and reconstructive plastic surgeon. All patients are counseled for nutrition optimization, tobacco cessation, and exercise therapy. Nicotine levels are screened for 6 to 12 weeks before surgery. In the operating room, regional anesthesia supplemented by general anesthesia allows patients to be fed and ambulated on the first postoperative day. Operative procedures are staffed jointly by abdominal and reconstructive surgeons.
Conclusion: Patients with fistulas or at high risk for complications related to lengthy procedures are treated with “damage control” technique, staged reconstruction, and care in the ICU. All postoperative and postoperative visits are coordinated through the nurse navigator and include visits to the abdominal and reconstructive surgery clinics on alternating weeks. Our team now supports other departments facing the complex abdomen including urology, Gynecology and spine reconstruction services.
Clinical Implications: Abdominal wall reconstruction team has become a resource within our medical group, hospital network, and community. Like hospital programs such as trauma care or burns, abdominal wall problems are best managed by a dedicated team.