Complex Hernia Repair

Some hernias are harder to repair than others. A hernia may be considered complex if it is large, has come back after surgery, affects several areas of your abdominal wall or occurs at a site of prior surgery.

At Banner Health, our surgeons provide advanced care for complex hernias and abdominal wall reconstruction. Your care team can help evaluate your hernia, explain your options and create a surgical plan tailored to your health, symptoms and goals.

What is a complex hernia?

A hernia happens when tissue or an organ pushes through a weak spot in the muscle or tissue wall. Many hernias are straightforward but some need more advanced planning, expertise or reconstruction.

A hernia may be considered complex if it is:

• Large
• Recurring after being repaired
• Located near a previous surgical incision
• Linked to infection, scar tissue or wound problems
• Causing a large gap or weakness in the abdominal wall
• Affecting more than one area
• Related to obesity, pregnancy, trauma or prior abdominal surgery
• Hard to repair because of other health conditions

What is abdominal wall reconstruction?

Abdominal wall reconstruction is surgery to repair and rebuild the muscle layers and tissues that support your abdomen. You may need this surgery if a hernia is large, complex or has weakened the abdominal wall.

Treatment is personalized because complex hernias vary widely. The goal is to close the hernia, support the abdominal wall and reduce the risk of the hernia coming back.

• The approach may be open, laparoscopic, robotic or a combination.
• Mesh may be used to strengthen the repair in some cases.
• Some repairs may use advanced surgical techniques to bring the abdominal muscles back together.

Types of hernias we treat

Banner Health surgeons treat many types of abdominal wall hernias, including:

• Incisional hernias: These hernias occur at a previous surgery’s incision site. They may develop months or years after the surgery.
• Ventral hernias: May appear as a bulge in the belly.
• Umbilical hernias: Happen near the belly button. Some are small, while others may grow or become more difficult to repair.
• Recurrent hernias: Comes back after repair. They may need more advanced planning.
• Large abdominal wall hernias: Can affect your abdominal strength, comfort, movement and daily activities.
• Inguinal hernias: Happen in the groin. Some are straightforward, while others may be more complex.
• Parastomal hernias: Hernias associated with a colostomy or ileostomy.
• Hiatal/paraesophageal/diaphram hernias: Hernias in which the stomach or other organs enter the chest.

Symptoms of a complex hernia

Symptoms can vary depending on how big the hernia is and where it is located.

Common symptoms include:

• A bulge in the abdomen or groin
• Pain or pressure near the bulge
• Pulling, burning or aching discomfort
• Pain that gets worse with lifting, coughing or standing
• Trouble with daily activities because of discomfort or the size of the hernia
• Nausea, bloating or changes in bowel habits
• Skin irritation or wound problems over the hernia

Get emergency care right away if you have any of these signs of a blocked or trapped hernia:

• Very painful
• Cannot be pushed back in
• Turns red or purple
• Happens along with fever, vomiting, severe belly pain or inability to pass gas or stool

When hernia repair may require a more advanced approach

You may need more advanced hernia surgery if your abdominal wall is weak, damaged or difficult to close.

This can happen with:

• Previous hernia repair
• Multiple abdominal surgeries
• Large hernia size
• Infection
• Mesh complications from previous surgery
• Scar tissue
• Obesity or major weight changes
• Smoking history
• Diabetes
• Chronic coughing
• Heavy lifting or physical strain
• Poor wound healing
• Hernias after trauma or cancer surgery

How complex hernias are diagnosed

Your surgeon will start with a physical exam and review your medical history, other surgeries and whether they used mesh, wound complications, symptoms and overall health.

Testing may include:

• CT scan
• Ultrasound
• MRI
• Blood tests

Treatment options for complex hernias

Treatment depends on the type of hernia, symptoms, hernia size, earlier surgeries and your overall health.

Watchful waiting

Your surgeon may suggest monitoring a small or low-risk hernia if it doesn't cause major symptoms. They can explain the risks and benefits of waiting compared to surgery.

Open hernia repair

You may need open surgery for large, recurring or complicated hernias. With open surgery, your surgeon can directly repair the abdominal wall.

Laparoscopic hernia repair

Laparoscopic surgery uses small incisions and a camera. It may be an option for some hernias depending on their size and location.

Robotic hernia repair

With advanced minimally invasive surgery, surgeons can perform certain repairs through small incisions with greater precision and better visualization.

Abdominal wall reconstruction

For a larger or more complex hernia, your surgeon may need to rebuild the abdominal wall. This may include bringing muscle layers back together and using mesh or other techniques to strengthen the repair.

Mesh repair

Mesh can support the repaired area and make it less likely that the hernia will come back. Your surgeon will explain why mesh may be recommended and any risks you should consider.

Preparing for complex hernia surgery

For some people, preparation before surgery can help lower the risk of complications and support healing.

Your care team may recommend:

• Managing blood sugar
• Losing weight
• Stopping smoking or nicotine use
• Improving nutrition
• Treating infection or skin problems
• Reviewing medications
• Planning for help at home during recovery
• Addressing chronic coughing or constipation
• Building strength before surgery

What to expect after surgery

Recovery depends on the type of repair, hernia size and your overall health. Some patients go home the same day, while others may need a hospital stay.

Your care team will give you instructions for:

• Pain control
• Incision care
• Activity limits
• Lifting restrictions
• Walking and movement
• Returning to work
• Wearing an abdominal binder, if recommended
• Watching for signs of infection or complications
• Follow-up appointments

Healing from complex hernia repair can take longer than recovery from a simple hernia repair. Your surgeon will outline what to expect based on your procedure.

A team-based approach to abdominal wall reconstruction

If you have a large hernia, wound concerns, prior mesh complications or other health conditions, your complex hernia repair may involve more than one type of specialist.

Your care team may include:

• General surgeons
• Minimally invasive or robotic surgeons
• Plastic and reconstructive surgeons
• Wound care specialists
• Bariatric or weight management specialists
• Primary care providers
• Diabetes care specialists
• Nutrition specialists
• Anesthesia and pain management teams

Why choose Banner Health for complex hernia repair?

At Banner Health, we provide surgical care for complex hernias, including abdominal wall reconstruction.

We offer:

• Open, laparoscopic and robotic surgical options
• General surgery and advanced minimally invasive surgery specialists
• Coordination with wound care, plastic surgery, nutrition, weight management or other specialists

Our surgeons can evaluate your hernia, discuss your treatment options and help you understand what to expect before and after surgery. Find a Banner Health hernia surgeon or surgery location and get the care you need.

FAQs about complex hernias

What makes a hernia complex?

A hernia may be complex if it is large, has come back after repair, occurs near a previous surgical incision, involves scar tissue or infection or affects a large part of the abdominal wall.

What is abdominal wall reconstruction?

Abdominal wall reconstruction is surgery to repair and rebuild the muscles and tissues that support the abdomen. It may be used for large, recurrent or complicated hernias.

Is abdominal wall reconstruction the same as a tummy tuck?

No. Abdominal wall reconstruction repairs a medical problem, such as a complex hernia or a weakened abdominal wall. A tummy tuck is usually a cosmetic procedure, though some patients may have overlapping concerns to discuss with a surgeon.

Can a complex hernia be repaired with robotic surgery?

Some complex hernias may be repaired with robotic-assisted surgery but not all patients are candidates. The best approach depends on the size, location and type of hernia, as well as your prior surgeries and overall health.

Will mesh be used in my hernia repair?

Mesh is often used in hernia repairs to strengthen the area but it is not right for every patient. Your surgeon will explain whether mesh is recommended for your repair.

How long does recovery take after complex hernia repair?

Recovery varies. A smaller repair may have a shorter recovery, while abdominal wall reconstruction or recurrent hernia repair may take longer. Your surgeon will give you activity, lifting and follow-up instructions based on your procedure.

Can a hernia come back after surgery?

Yes, hernias can come back after repair. Complex hernias may have a higher risk of recurrence. Careful surgical planning and managing risk factors like smoking, diabetes, weight and wound healing may help lower that risk.