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Welcome to the York Abdominal Wall Unit. We specialise in providing care for patients requiring abdominal wall reconstruction (AWR). On this website, we have described each step of the treatment process. Our aim is to explain what you might go through should you need surgery for this condition.
Abdominal wall reconstruction is a complex procedure. It is designed to repair significant defects in the abdominal wall. These defects are often large hernia (with a width of more than 10cm) in the tummy (abdomen) or moderately sized hernia but with other factors that make the situation complex (like the presence of a parastomal hernia, loss of domain - where much of the abdominal contents come out into the hernia sac, etc). These cause a higher complication rate and a higher rate of recurrence.
We have developed a service focussed on supporting you throughout your journey. We understand that this journey can be daunting, which is why we have structured our care pathway to support you at every stage.
Please explore the drop-down sections below to learn more about each phase of your treatment. From your initial referral to your follow-up care, we are here to answer your questions and provide the information you need to feel confident and prepared throughout your AWR journey.
Referrals to our service
Referrals for abdominal wall reconstruction can be made by your GP or a surgeon in our hospital who has already seen you.
If you believe you may benefit from our specialised care, please discuss this with your GP or surgeon, who can then refer you to our unit for further assessment and potential treatment.
What happens before your clinic appointment?
Before your visit to the York Abdominal Wall Unit, we will carry out a few steps to make sure your appointment is as effective and informative as possible.
By completing these steps before your clinic appointment, you help us create a personalised treatment plan that addresses your specific needs, ensuring that you are well-prepared for any future procedures.
Here is what you can expect in the lead-up to your clinic day:
Once your referral is received, our surgeons will write to the referring surgeon to request further information.
Before your appointment, you will be sent information about clinical photography. We take photographs of your hernia to help us plan treatment. The photographs are taken discreetly and with chaperones present.
You will receive a leaflet about clinical photography and a clinical photography consent form. Please review the information leaflet thoroughly and, once satisfied, sign your consent form. If you are not satisfied, you will be able to ask further questions in the clinic. Please bring your consent form to your appointment.
One of the crucial documents you will receive is the health screening questionnaire. This form is designed to gather detailed information about your health history, previous surgeries, and the specifics of your hernia. The information you provide helps our team understand your condition better and tailor your treatment plan.
The questionnaire includes several key sections:
Completing this questionnaire at home ensures you have enough time to reflect on your answers and provide us with accurate and detailed information. In turn, this means your clinic appointment can focus more on planning your care, rather than gathering data, making your appointment more efficient and productive.
On the day of your clinic or appointment
This comprehensive appointment is designed to ensure you receive all the information and support you need as you begin your treatment journey with us. Our team is committed to making your experience as smooth and comfortable as possible.
Upon arrival, you will check in at the clinic reception. Our friendly staff will confirm your details and direct you to the waiting area.
You will generally be seen by both a consultant gastrointestinal surgeon and a consultant plastic surgeon. Occasionally, we may start with only one of them seeing you. This consultation allows our team to assess your condition and collaboratively develop a personalised treatment plan.
We will look at your completed questionnaire and discuss details if needed. The information you have provided in the questionnaire will help us better understand your case. View the health questionnaire.
We will examine your hernia and may mark it with a temporary pen marker.
We will discuss a plan for your treatment. This is an opportunity to ask questions and express any concerns.
With your consent, clinical photographs of your abdominal area may be taken. These images are for documenting the size and location of your hernia and help us plan your surgery.
Depending on the outcome of your consultation, the next steps of your treatment plan will be discussed. This may involve scheduling further tests (such as a CT scan), planning your surgery, or getting you fitter before surgery.
Before you leave, you will be given additional information about what to expect about the next stages of your care. This might include written materials or details on how to contact the clinic with further questions.
CT scan
A Computed Tomography (CT) scan is an important imaging test that we often organise as part of your assessment. This scan uses X-rays to create detailed, cross-sectional images/slices of your abdominal area, allowing us to see the structures inside your body.
A CT scan helps us assess the size, location, and complexity of the hernia. This detailed view enables our surgeons to plan your treatment more effectively. By understanding the full extent of your condition, we can tailor our approach to meet your specific needs, ensuring the best possible outcome.
Clinical photography
As part of your care at the York Abdominal Wall Unit, clinical photographs may be taken to support the assessment, planning, and documentation of your treatment. These photographs are important for accurately recording the characteristics of your hernia, helping our surgical team provide the best possible care.
With your consent, photographs of your abdominal area will be taken during your clinic visit. The process is quick, secure, and conducted with your comfort and privacy in mind. The photographs are taken discreetly without compromising your dignity. There will be a chaperone. We will ensure you feel supported and if you want to discuss certain aspects there will be an opportunity to raise issues or concerns with your surgeons.
The images are stored securely and access is limited to those who are involved in your care.
You will be asked to sign a consent form specifying how the images can be used, ensuring your control over your personal information.
For more information, please refer to the following:
These resources provide detailed explanations about the process, storage, and usage of photographs so you can make an informed decision about your participation.
Finally, you will be asked to review and sign a consent form for the operation. This form confirms that you understand the procedure, the risks involved, and have agreed to proceed with the surgery.
Getting you fitter for surgery (Prehab)
Getting healthy before undergoing complex abdominal wall reconstruction (CAWR) surgery reduces the risk of complications and improves your recovery. The process is known as 'pre-optimisation' or 'prehabilitation' and involves making specific lifestyle changes to ensure your body is in the best possible condition before surgery.
Research has shown that patients who take steps to improve their health before surgery experience fewer complications, such as infections and wound breakdown. By optimising your health, you reduces the risk of complications, leading to a smoother and faster recovery.
Quitting smoking at least four to six weeks before surgery significantly enhances lung function and reduces the risk of post-operative complications. We will support you in giving up smoking.
Achieving a healthy weight decreases your risk of both general and specific complications during and after surgery. Our team can provide guidance on safe and effective weight loss strategies.
Good nutrition is vital for healing and recovery. Whether you need to gain or lose weight, eating a balanced diet helps ensure your body is ready for surgery.
Regular exercise improves your fitness and muscle strength, helping your body cope better with surgery and recovery.
Maintaining stable blood glucose levels is important for reducing the risk of infections and other complications.
Reducing alcohol intake improves liver function, helps you achieve a healthy eight, and supports better overall recovery.
Maintaining a positive outlook and managing stress can significantly impact your recovery, making mental wellbeing a key part of pre-optimisation.
We may offer you a rehabilitation course as part of our commitment to your treatment and recovery. This program, supported by our dedicated rehabilitation team, involves a series of weekly exercise classes designed to improve your fitness before surgery.
For more detailed guidance on preparing for surgery, you can refer to the following patient information leaflets:
These resources provide comprehensive information on how you can make the necessary changes and where to seek additional support.
Preoperative adjuncts (Botox or PPP)
As part of your preparation for complex abdominal wall reconstruction (CAWR) surgery, we may use preoperative 'adjuncts', such as botox injections and Preoperative Progressive Pneumoperitoneum (PPP). This can improve surgery outcomes by making the abdominal wall more flexible and facilitating hernia closure with less tension.
Botox and PPP are carefully selected based on your specific needs and are typically done as outpatient procedures.
Botulinum toxin (Botox) is injected into the muscles on either side of your abdominal wall to relax the muscles and make it easier to close the hernia defect with minimal tension. This can reduce the need for more invasive techniques during surgery and improve healing.
The procedure is quick, typically done as an outpatient using ultrasound guidance to ensure precise placement of the injections. There are many different preparations. In our unit, we use a preparation called 'Dysport'.
As botox is usually done around four weeks before surgery, this is also an opportunity to discuss any concerns about your surgery and review the surgery consent form.
In some cases, PPP is used to further prepare the abdominal cavity. This technique involves gradually inflating the abdomen with air over several days or weeks before the surgery. By stretching the abdominal cavity, PPP helps accommodate the return of abdominal contents during the repair of large hernias. This can reduce tension during closure and lower the risk of complications after surgery.
Pre-op planning/MDT discussion
Before your surgery, a detailed planning process takes place to ensure the best possible outcomes. Your case will be reviewed in a Multi-Disciplinary Team meeting with specialists from different areas (including radiologists, anaesthetists, and other surgeons).
These specialists will collaborate to plan every aspect of your surgery, including choosing the correct surgical approach, assessing potential risks, and planning your perioperative care.
This collaborative approach helps us create a comprehensive and tailored plan for your procedure.
Perioperative assessment (CPET)
Before your surgery, you will meet with our anaesthetic team to review your overall health, including any other medical conditions that might affect your surgery or increase the risk of complications.
Our anaesthetists carefully assess all factors to develop a tailored anaesthesia plan that ensures your safety and comfort during the operation. In some cases, they may arrange for Cardiopulmonary Exercise Testing (CPET) to evaluate how well your heart and lungs function under stress.
See more information about CPET.
A perioperative nurse will provide detailed instructions on preparing for surgery and what will happen on the day. They will also give you a small instrument called an incentive spirometer, which helps in taking deep breaths.
Your surgery day
On the day of your surgery, several important steps are taking to ensure everything is ready.
When you arrive, our team will confirm all necessary details, including your personal information, the planned procedure, and any specific instructions you were given before surgery.
before your surgery begins, your surgeon will carefully mark the area of your hernia. This is a crucial step to ensure accuracy during the procedure.
Finally, you will be asked to review and sign a consent form for the operation. This form confirms that you understand the procedure, the risks involved, and have agreed to proceed with the surgery. The specific procedure(s) will be as detailed on the consent form.
You can see a copy of the consent form below.
Your surgeon will take a photograph on the morning of the surgery.
Your complex abdominal wall reconstruction (CAWR) surgery is a carefully planned procedure designed to prepare and reinforce the abdominal wall. This surgery addresses hernias and other abdominal wall defects that can significantly impact your health and quality of life.
During the operation, the techniques used depend on your individual case. We may use mesh to strengthen the abdominal wall, or use advanced methods like component separation techniques to bring the muscles together with minimal tension.
The main goals of your surgery are to restore the function of your abdominal wall, reduce the risk of future complications like bowel strangulation, and improve the overall shape and stability of your abdomen.
Your surgical team will tailor the procedure to your unique needs, ensuring the best possible outcome.
For more detailed information about your surgery, including the specific techniques we use, please refer to the complex abdominal wall hernia leaflet.
After your surgery
After surgery, you will be closely monitored during your stay in hospital. The length of your stay depends on the complexity of your surgery and how well you are healing.
During this time, your care will be managed by the multidisciplinary team, including surgeons, perioperative nurses, and physiotherapists. We will manage your pain, care for the wound, and support you to gradually increase your activity level. Your vital signs will be regularly checked and your progress will be closely monitored to detect any potential complications early.
Our goal is to help you recover safely and return home as soon as possible.
Your follow-up care is an important part of your recovery after surgery. Typically, we will schedule a follow-up appointment about three months after your surgery.
During this visit, we will assess your healing, address any concerns, and discuss your overall recovery. We will take further photographs to document the results of your surgery and compare the outcome to your original hernia.
This follow-up helps us check are no complications and ensure you are healing properly.
Links to all patient information leaflets and consent forms
Feedback and audit
We are committed to continuously improving our service and listening to our patients, ensuring that your feedback and regular audits play a key role in shaping how we care for future patients.
We regularly conduct audits to ensure the highest quality of care. An audit is a review of our services, focusing on surgical outcomes and patient satisfaction. This process helps us monitor the effectiveness of our treatments, enhance patient safety, and continually improve our practices. Your data is used confidentially to help us refine our care, ensuring better outcomes for all patients.
We also ask for feedback from our patients to learn how we might improve our service. Your experiences help us understand what works well and where we can make positive changes.
Address: Department of General Surgery, 4th Floor, York Hospital, York, YO31 8HE
Email: andrea.cussans@nhs.net
Please help us prioritise our most unwell patients by choosing the right service for your symptoms. Only attend in a life-threatening or emergency situation. Find the right help for your symptoms at http://111.nhs.uk.
