Hernias, Diastasis & Abdominal Wall Reconstruction

I managed all forms of abdominal wall hernias, including groin (inguinal), femoral, Spigelian, ventral, umbilical (bellybutton), incisional (after previous surgery) and recurrent hernias (after previous operations). I have a keen interest in the management of postpartum diastasis of the abdominal rectus muscles. For this I often can provide minimally invasive approaches for their repair, reducing downtime, enhancing recovery and improving cosmesis. As one of the only surgeons in Australia, I offer the so-called MILA procedure (minimally-invasive lipo-abdominoplasty) in conjunction with a highly experienced body-contouring plastic surgeon.

Finally, I have a keen interest in the management of complex abdominal wall reconstruction, often performing extensive abdominal wall hernia procedures multiple times per week. Most of these surgeries can be performed minimally-invasively including using the surgical robot, but often in the setting of multiple recurrent hernias or excess skin, open operations may be required.

I also deal with mesh complications and perform mesh explantations when required. I have experience in managing patients with chronic inguinal pain following groin hernia repairs.

Inguinal, femoral and other groin hernias

Inguinal & femoral hernias are some of the most common groin hernias encountered. They can often be readily diagnosed by a visible bulge in the groin that is associated with discomfort, "pulling/burning", or frank pain when performing activities of daily living. Most groin hernias can be repaired laparoscopically / robotically resulting in very short down time, quick return to activities and work and lower risks of pain following surgery.

Ventral hernias

Ventral hernias come in a variety of presentations. They can be belly button hernias, or also in the midline above the belly button. Very often they are so-called "primary" hernias, so they have developed without a clear cause. However, often ventral hernias can occur after previous surgery, although technically they should then be called "incisional hernias". Irrespective, whilst common, it's often the small hernias that can cause the most controversy in regards to how they should best be repaired (if at all). Careful patient assessment, often including a thorough history, examination and use of modern imaging technology is necessary to work out which repair is best suited to which hernia and most importantly which patient.

Diastasis of the Rectus Abdominis Muscle (DRAM) / Muscle Separation

Separation of the six pack muscles, also known as diastasis recti (DR/DRAM) is a fairly common condition that occurs with ageing, weight gain and in some cases can be hereditary. However, it is most commonly encountered following pregnancies, in particular pregnancies of large babies, twins, or traumatic pregnancies. DRAM is a very poorly understood condition, which is however thankfully gaining more attention from many women's health doctors, physiotherapists and surgeons. Whilst "tummy tucks" / abdominoplasties have been performed for a long-time, many have focussed on the cosmetic and not functional results of these important surgeries. Equally, addressing diastasis during hernia repairs is conceptually something which has only recently emerged, but increasingly understood as being an essential component of reducing hernia recurrences. Furthermore, new technological developments allow surgeons to perform the surgical correction of diastasis minimally invasively greatly reducing down time and at times even improving surgical cosmesis. In particular women of lower body-weight with no excess skin, can greatly benefit from minimally invasive repairs. I am proud to be one of the few surgeons in Australia who is formally trained in the new so-called M.I.L.A. surgery (minimally invasive lipo-abdominoplasty), which allows for the minimally invasive correction of diastasis, whilst also performing body-sculpting and skin-tightening procedures together with a plastic surgeon. For more information on this procedure, please see my blog post.

Complex abdominal wall reconstruction surgery

Hernia surgeries don't always go to plan. And sometimes hernias are neglected for a variety of reasons, whereby the hernias can reach grotesque and debilitating dimensions. I specialise in managing some of the most complex abdominal wall hernias that exist. Multiple previously failed repairs, hernia repairs in the context of intestinal fistulas, hernias with infected mesh, or skin breakdown, hernias in patients with high risk comorbidities include just some of the complex conditions that I help manage. Equally, I work closely with a colorectal surgeon for the management of larger or recurrent parastomal hernias.

The advent of surgical robotics has been an absolute game changer for patients suffering from these complex conditions. Often surgeries which were previously only possible with open operations, can now be performed with small cuts, resulting in dramatically reduced lengths of hospital stay, pain as well as enhanced recovery. However, minimally invasive surgery is not always the best approach for patients suffering from complex & chronic hernia conditions. Often, infected, broken down or excess skin needs to be addressed to allow for an optimal functional result to ensue. By working with and having trained under some of the countries leading experts in hernia care, I feel privileged to take care of my patients suffering from these often at times neglected conditions. I am a proud member of the Australia & New Zealand Hernia Society Subcomittee Board.