Abdominal Core Health—A Needed Field in Surgery

Abstract

Most members of the board of governors at the Americas Hernia Society aim to redefine the field of hernia care as abdominal core health, the discipline as abdominal core surgery, and the identity of associated clinicians as abdominal core surgeons. The abdominal core is defined as the circumferential soft tissues of the diaphragm superiorly, the pelvic floor inferiorly, and the abdominal wall and flank anterolaterally, excluding the abdominopelvic viscera (Figure). This concept has been described before, as outlined by Wood et al. 1 The field of abdominal core health encompasses the stability and function of the abdominal core and associated quality of life. Maintenance of abdominal core health may include exercise, physical therapy, medical therapy (including compression garment or truss use), alternative medical therapies (including acupuncture or yoga), surgical intervention, and measures to prevent disease (eg, hernia prophylaxis). Disease processes involving abdominal core health include intrinsic diseases of the abdominal wall (eg, hernia, diastasis, athletic pubalgia or core muscle injury, benign tumors, malignant tumors) and extrinsic diseases of the abdominal wall (eg, prosthetic or intervention-associated complications, benign tumors, malignant tumors).Establishing abdominal core health as a new field would have the potential for sweeping change. The anticipated benefits of this change include (1) reinventing the field to be reflective of the actual care physicians provide to patients; (2) providing a fresh, new, and innovative brand for a discipline of surgery that has historically appealed only to a narrow clinician demographic; (3) increasing the multidisciplinary scope of practitioners who would help care for patients, including general surgeons (and associated subspecialists), plastic surgeons, physical medicine and rehabilitation specialists, exercise physiologists, physical therapists, and those focused on disorders of the pelvic floor; (4) giving clinicians a renewed identity as specialists in abdominal core health and abdominal core surgery, focusing on what unites them for a comprehensive approach to health promotion and not simply disease management; (5) enabling research collaboration focusing on the abdominal core as a holistic entity and integral part of patients' lives; (6) redefining medical education by creating a comprehensive didactic approach to one of the most dynamic and complex areas of the body, the abdominal wall, and not just a focus on hernia; and (7) improving opportunities for philanthropy, research, quality improvement, and device surveillance by taking an area with largely negative connotations of disease (hernia) and transforming it into a field with a positive connotation of health (abdominal core health).As a professional organization, the Americas Hernia Society will (1) encourage the adoption of the concept of abdominal core health for surgeons, allied health

Surgical repair of diastasis recti abdominis provides long-term improvement of abdominal core function and quality of life: a 3-year follow-up

“…DRA is one of several pathological components 5 of a generally stretched abdominal wall after pregnancy and can predispose for abdominal core dysfunctions such as back pain, abdominal core muscle weakness and poor posture 6–11 . The abdominal core, defined as the circumferential soft tissues of the diaphragm superiorly, the pelvic floor inferiorly and the abdominal wall and flank anterolaterally 12 , is crucial for upholding the posture and abdominopelvic visceral function. Risk factors for developing DRA include multiparity, advanced maternal age, caesarean section and collagen disposition 13 , 14 .…”

A Primer for Success as an Early Career Academic Plastic Surgeon

“…For example, the senior author (JEJ) is a co-director and co-architect of the Center for Abdominal Core Health, which engages multiple disciplines in the care of patients with abdominal wall defects. 52 Another author (IK) leads his institution’s multidisciplinary hemangioma and vascular malformations program.…”

A load sharing principle in abdominal wall reconstruction: Communication and collaboration among plastic & reconstructive surgeons, oncologic surgeons and general surgeons

“…Abdominal wall reconstruction and hernia repair surgery continue to evolve with the intention to successfully repair the abdominal wall, restore muscular dynamics, and minimize recurrences. This trio of expectations is now being comprehensively defi ned as "Abdominal Core Health" and has many physical and mental benefi ts [1,2]. Repair of primary and recurrent abdominal wall hernias with component separation and Strattice acellular dermal matrix is a technique where plastic surgeons and general surgeons work closely together to close abdominal walls and optimize functional as well as aesthetic outcomes reestablishing abdominal core health [3,4].…”