Practical approach to patient with a hostile abdomen

Despite significant advances in surgical techniques and in approaches to surgical diseases, the timing of reoperative surgery, particularly in patients with a visibly hostile abdomen, is unclear. Reoperative surgery in such patients is challenging and requires significant resources, both surgical and financial, and therefore careful planning; it should be individualized (i.e., tailored) for each patient and each condition. In the absence of objective data and randomized studies and in the face of an ever-increasing number of patients’ requests to be “fixed,” the surgeon has to rely on personal expertise and, often, gut feeling. Clearly, open and active communication among the surgical team, the patient, and the patient’s family is the key. Everyone should fully understand the need for complex abdominal wall reconstruction. The patient's motivations must be sound, with realistic goals and expectations regarding the outcome and with a thorough understanding of possible complications.