What Is A Complex Hernia

hernia occurs when an organ —such as the intestine or fatty tissue—pushes through an opening in the muscle layer of the abdominal wall. Hernias are more common in men. It is estimated that 25 percent of men and about 3 percent of women will develop a hernia at some point in their lifetime.

A hernia can become complex due to several reasons: large hernias (greater than 4 inches or 10 cm), recurrent hernias (hernias that came back after being previously repaired), and/or hernias with wound or mesh infections. Hernias can also be complicated due to their location, previous surgery, obesity, diabetes and other medical conditions. Each time a surgical attempt to close the opening in the lining of the abdominal wall location fails, the nature of the complexity and severity increases. The patient’s surrounding tissues can become stretched or weakened, reducing the possibility of positive outcomes.

Many people with complex hernias believe they must live with the condition, being debilitated or facing a diminished quality of life. There is often a concern that life will never feel normal again. There can be a fear of:

  • A lessened quality of life
  • Morbidity
  • Limited mobility
  • Psychological well-being
  • Stress related to health and weight management
  • Greater degrees of body pain
  • Diminished social and physical functioning
  • Lessened sexual activity
  • Missed opportunities
  • Occupational and career limitations
  • Related health problems
  • Loss of pastimes and hobbies

We understand your worries.

Helping hernia patients regain an improved quality of life is our sole focus.

There is hope at The Iskandar Complex Hernia Center.

You deserve
renowned expertise and
unparalleled compassion.


More Medical Information about Complex Hernias

Complex Hernia vs. Basic Hernia

Not all hernias are complex. When a hernia is present and especially when a hernia reoccurs, an experienced complex hernia surgeon should be consulted.

What makes a hernia complex?

The simplest answer is that it is a “high risk” type of hernia, either due to the characteristics of the hernia or to certain conditions with which the patient may live. These characteristics and conditions make the repair technically challenging and may also carry a higher than usual risk. Therefore, specialized care in these cases will help minimize the overall risk.

A more nuanced answer is the complex hernia is determined from a combination of:

Hernia Size

The width of the hernia opening typically defines its degree of complexity more than the length of the hernia. A hernia of more than 4 inches (10cm) in width could indicate a complex designation.

Hernia Location

There are several areas of the body in which hernia repairs are more challenging.

  • The back or side (lumbar or flank)
  • Below the belly button where two muscle groups join (lateral/Spigelian)
  • upper abdomen below the rib cage (subcostal)
  • Diaphragmatic hernias (paraesophageal, Morgagni and Bochdalek hernias)

Previous Surgeries

Surgeries can weaken the abdominal wall—especially the muscle layer because our bodies heal by producing scar tissue instead of regenerating new muscle tissue. Unfortunately, scar tissue is weaker than our own tissue. Previous wound infections may also weaken the tissue further.

Hernia Patient History

If a patient has problems in the wound healing process, this can lead to weakened scar tissue. As a result of weakened tissue, a hernia can reopen at the point of scarring. Some conditions that lead to poor wound healing include diabetes, malnutrition and smoking.


Obesity is a risk factor for formation of hernias and for hernias recurring after being removed or repaired due to pressure that excess weight places on a healing wound, in addition to other conditions that sometimes accompany obesity such as diabetes. Moreover, obesity can lead to more adverse events such as blood clots, wound infections and pneumonias. Therefore, it is crucial to achieve some weight loss prior to hernia repairs for better results.

Symptoms of a complex hernia include:

  • A large bulge in the abdominal region or site of a previous incision/scar
  • Abdominal discomfort (mild or severe pain)
  • A bulge in the abdominal or groin region that is often tender to touch
  • Constipation
  • Nausea and/or Vomiting
  • Draining fluid from a site of previous hernia repair

More serious complex hernia complications include:

  • Infections: Especially those that develop drainage of fluid from an infected mesh.
  • Fistulas: When there is stool or greenish fluid coming out through an opening in the skin.
  • Wound Reopening: A wound dehiscence is when the previous hernia surgery suture wound does not heal but, instead, opens up partially or completely at the point of the initial incision to create a new wound or new hernia.
  • Bowel obstruction: When herniated tissue becomes trapped and cannot easily be moved back into place into the body cavity, leading the bowels may become obstructed or strangulated. Often, this occurs with the small intestine and requires emergency surgery.

The risk and complications associated with abdominal wall hernias warrant not ignoring the symptoms. Hernia patients and their health and care are the sole focus of the Iskandar Complex Hernia Center.

A Revised Definition and More Focused Approach

A previous question faced by the doctors was defining what constituted a complex hernia. It was often defined by “you will know it when you see it” type of language. However, in 2013, a more formal definition was created and further clarified in 2018 as shared above.

Complex abdominal wall defects are a more challenging dilemma faced by general surgeons and plastic surgeons. As such, a new field is emerging where the surgeon focuses primarily on complex hernia surgery and abdominal wall reconstruction. This is the sole focus of the Iskandar Complex Hernia Center.

Diagnosing Your Complex Hernia — A Full Spectrum Approach to Health and Wellness

Dr. Iskandar, MD, FACS and his team have experience in gathering and assembling the needed patient history and performing a full physical exam to determine the presence and extent of a hernia.

In addition, the Iskandar Center utilizes Computed tomography (CT) scans to evaluate the complexity of your hernia. CT scans of the abdominal wall is an excellent tool for assessing hernia characteristics. A recent study revealed that utilizing CT scans allowed for the better detection of hernia recurrence after mesh repair. Using CT scanning as compared to physical examination alone increases the detection rate of hernias by 98% .

The use of CT in your diagnosis better reveals the possibility of infection or additional hernias, allowing fewer unexpected events before your repair.

If your physician thinks you have a hernia, please consider having him/her refer you to The Iskandar Complex Hernia Center for further evaluation.

Armed with years of experience, an awareness of the latest innovation in research and treatment, and leading-edge imaging technology, Dr. Iskandar, MD, FASC will make an informed diagnosis of your condition, provide surgical treatment options, and clearly and simply communicate to you and your family the prognosis of possible outcomes. You’ll know you are at a world-class medical center in the caring hands of a skilled hernia surgeon whose sole focus is helping nurture and enhance your quality of life.

Schedule Your Evaluation

The Iskandar Complex Hernia Center is located at Baylor Scott & White Medical Center Waxahachie, 20 minutes south of the Dallas-Fort Worth metroplex. The hospital environment allows for collaboration with multiple disciplinary teams and a comprehensive operating environment to deal with medical emergencies should they be needed.


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