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Abdominal Wall Repair in Intestinal Failure

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Intestinal Failure

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Abstract

Intestinal failure (IF) begets abdominal wall failure and abdominal wall failure may beget intestinal failure. Abdominal wall repair in IF patients may be related to tissue loss or an open abdomen in the acute setting or their sequelae with single larger defects or multiple herniae in the chronic setting. Often IF patients have had multiple operations and will have incisional hernias. They may have one or more small hernias or their abdomen may have been left open as a laparostomy at the original abdominal catastrophe and therefore have a large hernia. In the acute setting obtain fascial closure by whatever means including staged closure with mesh mediated fascial traction as open abdomens are fistulogenic. The first priority of an IF patient is safely restoring intestinal integrity and nutritional autonomy. Abdominal wall surgery can be performed simultaneously but don’t shy away from staged surgery if needed. Prepare patients preoperatively both physically and psychologically. Put cases through an abdominal wall MDT involving expert radiologists and plastic surgeons as well as IF and AWR surgeons. Consider preoperative adjunctive including botulinum toxin injection and if loss of domain is a problem consider a possible role for progressive preoperative pneumoperitoneum. Choose mesh type, size and characteristics on a case by case basis after careful surgical and microbiological review.

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Acknowledgement

The authors wish to thank Mr. Henk Giele, Consultant Plastic, Reconstructive and Hand Surgeon, John Radcliffe Hospital, Oxford University Foundation Hospitals NHS Trust, for his review of this chapter.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Intestinal Rehabilitation Unit, St Mark’s Hospital, London, UK

    Akash Mehta

  2. Department of Colorectal Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK

    Ciaran Walsh

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  1. Akash Mehta
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Correspondence to Akash Mehta .

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  1. St Mark’s Hospital, Harrow, Middlesex, UK

    Jeremy M.D. Nightingale

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Mehta, A., Walsh, C. (2023). Abdominal Wall Repair in Intestinal Failure. In: Nightingale, J.M. (eds) Intestinal Failure. Springer, Cham. https://doi.org/10.1007/978-3-031-22265-8_60

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  • DOI: https://doi.org/10.1007/978-3-031-22265-8_60

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