Restoring strength,
function and form.
From straightforward hernia repair to complex abdominal wall reconstruction, my approach considers the abdominal wall as a whole.
This includes ventral and incisional hernia repair, rectus divarication repair, and combined abdominal wall reconstruction with abdominoplasty where appropriate.
Book an assessmentTreatment tailored to the problem
Not every abdominal wall problem is the same. Treatment depends on whether the underlying issue is a hernia, rectus divarication, excess skin and soft tissue, or a combination of these.
Hernia Surgery
Groin, umbilical and other common hernias, treated using open or minimally invasive techniques according to the individual hernia and patient.
Learn more →Ventral & Incisional Hernia
Repair and reconstruction of abdominal wall hernias, including larger, recurrent and more complex defects.
Learn more →Rectus Divarication
Reconstruction of separation and weakness of the central abdominal wall, with plication and resorbable mesh reinforcement.
Learn more →Abdominoplasty & Reconstruction
Combining abdominal wall repair with removal of excess skin and soft tissue to address both function and abdominal contour.
Learn more →Not sure what you have?
An abdominal bulge or change in abdominal shape may be caused by a hernia, rectus divarication, excess skin and soft tissue, or a combination of these.
Sometimes the distinction isn't obvious. An abdominal wall assessment can identify the underlying problem and help determine whether physiotherapy, weight optimisation, surgery, or a combination of approaches is most appropriate.
Book an abdominal wall assessmentPreparing for abdominal wall reconstruction
For larger abdominal wall repairs, preparation before surgery can be just as important as the operation itself.
Where appropriate, I use a structured prehabilitation approach aimed at improving the conditions for surgery while maintaining strength and muscle mass.
An individualised approach rather than a rigid BMI threshold.
Modern obesity treatments such as semaglutide and tirzepatide may help selected patients achieve substantial preoperative weight loss.
Supporting wound healing while helping preserve lean muscle during weight loss.
Improving conditioning before surgery rather than simply aiming to become lighter.
Optimising modifiable risks that can influence wound healing and postoperative complications.
Preparing for time away from work, activity restrictions and support at home after surgery.
Looking beyond the hernia defect
A ventral hernia can be part of a broader problem involving the abdominal muscles, previous scars, excess skin and soft tissue, and the overall strength of the abdominal wall.
In selected patients, treating these elements together allows the abdominal wall to be reconstructed as a whole rather than simply closing the hernia opening.
Ventral & incisional hernia
Reconstruction is tailored to the size, location and complexity of the defect, previous operations and the quality of the surrounding abdominal wall.
Rectus divarication
Significant separation of the rectus muscles can be reconstructed with midline plication and reinforced with a resorbable mesh onlay.
Abdominoplasty
When significant redundant skin and soft tissue coexist with abdominal wall weakness, abdominoplasty can form part of the reconstruction rather than being treated as a separate problem.
Reinforcement without necessarily leaving permanent mesh
Some abdominal wall repairs benefit from additional mesh reinforcement. Permanent synthetic mesh remains an important option for many hernia repairs.
For selected abdominal wall reconstructions, I use Phasix, a long-term resorbable synthetic mesh made from poly-4-hydroxybutyrate (P4HB).
In rectus divarication repair, my approach is to reconstruct the midline with fascial plication and reinforce the repair with Phasix placed as an onlay. The mesh provides reinforcement during healing and remodelling before gradually being absorbed.
I favour this approach because it allows mesh reinforcement of the reconstruction without necessarily leaving permanent synthetic mesh in the abdominal wall.
Mesh choice remains individual. Some hernias are better treated with permanent reinforcement, and the appropriate technique depends on the anatomy and requirements of each repair.
Abdominoplasty, function and form
For some patients, repairing the hernia or rectus divarication alone does not address the entire abdominal wall problem.
Pregnancy, major weight change and previous abdominal surgery can leave a combination of muscle separation, abdominal wall weakness and redundant skin and soft tissue.
Combining abdominal wall reconstruction with abdominoplasty allows these problems to be addressed during the same operation. The aim is a strong functional reconstruction while also considering abdominal contour.
Hernia repair, rectus plication, mesh reinforcement, removal of excess skin and soft tissue, and repositioning or reconstruction of the umbilicus where required.
Not every patient needs an abdominoplasty or mesh reinforcement. The operation is tailored to the anatomy of the abdominal wall, previous surgery, general health and what the patient hopes to achieve.
When to consider abdominal wall referral
I am happy to assess patients where the appropriate treatment pathway is uncertain, particularly when hernia, rectus divarication and excess abdominal skin coexist.
- Symptomatic ventral or incisional hernia
- Recurrent abdominal wall hernia
- Significant rectus divarication with functional symptoms
- Abdominal wall laxity following pregnancy or major weight loss
- Hernia or divarication associated with redundant abdominal skin
- Patients who may benefit from preoperative weight optimisation
- Consideration of combined abdominal wall reconstruction and abdominoplasty
Discuss your abdominal wall
An assessment can determine whether the problem is a hernia, rectus divarication, excess skin and soft tissue, or a combination, and what treatment options are appropriate.
