General and complex abdominal surgery covers the operations Dr. Jabbar performs for hernias, abdominal wall reconstruction, and other general abdominal procedures that frequently arise in his practice. Hernias account for most of the volume here, ranging from straightforward inguinal hernias to large, recurrent incisional hernias that require complex reconstruction with mesh and component separation. The page also covers appendectomy, small bowel resection, port placement for chemotherapy access, diagnostic laparoscopy for cancer staging, and feeding tube placement.
This page describes the conditions Dr. Jabbar treats and the operations he performs, written for patients and families who want to understand what their diagnosis means and what surgery actually involves.
The conditions below are the most common reasons patients are referred to Dr. Jabbar’s practice for general and complex abdominal surgery. Each is covered briefly, focusing on the patterns that come up most often in the clinic.
A hernia is a defect or weak spot in the abdominal wall through which internal tissue — usually fat, sometimes a loop of bowel — pushes outward, creating a visible or palpable bulge. The three most common types are named for where they sit. Inguinal hernias occur in the groin and are by far the most common type. Umbilical hernias occur at the belly button. Ventral hernias occur along the front of the abdomen, often at the site of a prior surgical incision (in which case they are called incisional hernias).
Symptoms depend on the type and size. The most reliable sign is a visible bulge that becomes more obvious when standing, coughing, or straining. Other symptoms include burning, aching, or pressure at the bulge site; groin discomfort with bending or lifting (for inguinal hernias); and, in men, pain or swelling that extends into the scrotum. Umbilical hernias in children are usually painless; in adults, they often cause some abdominal discomfort along with the bulge.
Risk factors include a congenital weakness in the abdominal wall (especially for inguinal hernias), male sex (which carries 8 to 10 times the risk for inguinal hernias), older age, family history, chronic cough (often from smoking), chronic constipation, repeated heavy lifting or straining, pregnancy, and obesity. Adult umbilical hernias are more common in women, particularly after multiple pregnancies.
Diagnosis is usually made on physical exam: the surgeon feels for a bulge while the patient stands, coughs, or strains. Imaging (ultrasound or CT) is used when the exam is unclear, when a hernia is suspected but not obvious, or to assess the size and contents before planning a complex repair.
Surgery is the only way to close an adult hernia, but watchful waiting can be reasonable for selected minimally symptomatic patients. When repair is chosen, mesh is used in many cases; the technique and timing depend on symptoms, anatomy, and patient risk. Infant umbilical hernias are different — most close on their own by age 3 or 4 and are watched first.
An incisional hernia is a defect in the abdominal wall at the site of a previous surgical incision, where the fascia (the strong connective tissue layer beneath the skin and fat) failed to fully heal. A “complex” or recurrent incisional hernia is one with additional features that make it more difficult to repair: large size, prior failed repairs, loss of abdominal domain (the abdominal contents no longer fit back inside without producing high pressure), contamination or active infection, or complications from mesh placed at a previous operation.
Symptoms include a bulge along or near a previous surgical scar that often grows over time; pain or weakness at the bulge that worsens with standing, lifting, or straining; skin changes over the bulge in chronic cases (thinning or irritation); difficulty with normal activity; posture changes; and back pain from altered core mechanics. Episodes of sharp pain or intestinal blockage can occur if the hernia becomes incarcerated (stuck) or strangulated (blood supply cut off), which requires urgent surgery.
Risk factors include prior abdominal surgery (the necessary precondition), surgical-site infection or wound healing problems at the original operation, obesity, smoking, poorly controlled diabetes, malnutrition, immune suppression, chronic cough or COPD, ascites, and prior failed hernia repairs — the risk of recurrence climbs with each subsequent operation.
Diagnosis is made on physical exam and confirmed with CT imaging. CT is the standard for complex cases because it shows the size of the defect, the loss of domain, the location and condition of any prior mesh, and any bowel involvement. This information drives the surgical plan.
These hernias are not amenable to simple repair. The treatment is abdominal wall reconstruction with mesh, often combined with a component separation technique to provide enough mobility to close the defect under reasonable tension. Optimization before surgery (weight loss, smoking cessation, glucose control, nutritional support) is often part of the plan to reduce the risk of recurrence after the operation.
Diastasis recti is a widening of the connective tissue (the linea alba) that runs down the middle of the abdomen between the two halves of the rectus abdominis muscle (the “six-pack” muscle). The result is a visible separation between the two sides of the muscle, most noticeable when the patient sits up or strains.
Diastasis recti is not a true hernia. There is no defect in the fascia and no protrusion of abdominal contents. It is often mistaken for a hernia because the midline bulge looks similar from the outside, but the underlying anatomy differs.
Symptoms include a visible ridge or dome-shaped bulge running vertically down the middle of the abdomen (most obvious when sitting up from lying down or when straining), a soft gap between the two sides of the abdominal muscles when palpated, a weak core, poor posture, lower back pain, difficulty lifting or stabilizing the trunk, and sometimes pelvic floor problems such as urinary incontinence.
The most common cause is pregnancy, especially multiple pregnancies, large babies, or twins. Other contributors include central obesity in men, repeated heavy lifting or improper abdominal exercise, prior abdominal surgery, and a genetic predisposition to connective tissue laxity.
Diagnosis is made on physical exam. The patient lies down and lifts the head, and the examiner palpates the midline for a gap, measuring its width in finger-breadths or with a caliper. Ultrasound or CT is used when a suspected umbilical or epigastric hernia is also present.
The first-line treatment is conservative. Targeted physical therapy focuses on deep abdominal and pelvic floor strengthening and on avoiding exercises (such as standard crunches) that can worsen the separation. Surgical repair (plication of the linea alba, sometimes combined with hernia repair or abdominoplasty) is reserved for patients with persistent symptoms or functional impairment after a dedicated trial of physical therapy, or when a true coexisting hernia is also present.
The procedures below are the most common operations Dr. Jabbar performs for the conditions described above, along with several supportive procedures that frequently arise in his practice. Whenever the disease and anatomy allow, they are performed robotically or laparoscopically through small incisions. When the case requires it, the same operations are performed open.
Hernia repair restores the integrity of the abdominal wall by returning the protruding tissue to the abdomen and reinforcing the defect, almost always with synthetic or biologic mesh. Mesh repair has largely replaced pure tissue repair (sewing the defect closed without mesh) because it provides a stronger, more durable result with lower recurrence rates.
Hernia repair is performed for symptomatic inguinal, umbilical, or ventral hernias; for any hernia at risk of incarceration or strangulation; for recurrent hernias; and for adult hernias that will not resolve on their own.
There are three main surgical approaches:
Hospital stay depends on the type of hernia and the approach. Most inguinal hernia repairs and small umbilical hernia repairs are performed on an outpatient basis. Larger ventral or incisional hernia repairs may require one to three nights in the hospital. Full recovery typically takes several weeks, with specific lifting restrictions depending on the size and complexity of the repair.
Abdominal wall reconstruction (AWR) is a planned, complex operation to rebuild a structurally compromised abdominal wall in patients with large, recurrent, or complex ventral and incisional hernias. It is a different operation from a routine hernia repair, both in approach and in recovery.
The operation is indicated for incisional hernias that are typically larger than about 10 centimeters wide, hernias that have recurred after one or more prior repairs, hernias with loss of abdominal domain, hernias complicated by prior mesh problems or contamination, and parastomal hernias related to ostomies.
The core technical concept is component separation. By releasing one of the lateral abdominal wall muscle layers, the surgeon creates enough mobility for the rectus muscles to slide back to the midline and close the defect without excessive tension. Two main techniques exist. Anterior component separation (the Ramirez technique) releases the external oblique fascia. Posterior component separation with transversus abdominis release (TAR) is one established technique: it creates a large retromuscular space for a wide piece of mesh while preserving the blood supply to the skin.
These operations can be performed open, laparoscopically, or robotically. Robotic TAR is one option for selected patients. The choice among open, laparoscopic, and robotic repair depends on the hernia, prior operations, patient factors, and surgeon expertise.
Hospital stay varies. Hospital stay after abdominal wall reconstruction varies with the size and complexity of the repair, the approach used, and the patient’s recovery. Selected patients undergoing minimally invasive repair may have a shorter stay than patients undergoing open reconstruction. Surgical drains and an abdominal binder are common. Full recovery takes six to twelve weeks, and lifting restrictions are strict during that time to give the repair time to mature.
An appendectomy is the surgical removal of the appendix, a small finger-shaped pouch off the cecum (the first part of the colon). The appendix is removed when it becomes acutely inflamed (appendicitis), one of the most common reasons for emergency abdominal surgery in adults. The operation is also performed for appendiceal masses or tumors found incidentally on imaging, for neuroendocrine tumors of the appendix found on pathology, and as part of staging operations for some abdominal cancers.
There are three approaches. Open appendectomy uses a single small incision in the right lower abdomen. Laparoscopic appendectomy uses a few small incisions with a camera and instruments. Robotic appendectomy is a minimally invasive option. The choice among open, laparoscopic, and robotic approaches depends on the clinical situation, anatomy, concurrent procedures, and surgeon expertise. Conversion to open surgery is more likely when the appendix has ruptured, when there is widespread infection, or when an abscess requires drainage.
Hospital stay is typically one to two days for an uncomplicated minimally invasive appendectomy, and same-day discharge is sometimes possible. Recovery to normal activity takes a few weeks — longer if the appendix ruptured before the operation.
A small bowel resection is the surgical removal of a diseased segment of small intestine, followed by reconnecting the healthy ends (an anastomosis). The robotic approach uses small incisions and the robotic platform for precise dissection and intracorporeal suturing.
Indications include Crohn’s disease that has produced strictures, small bowel tumors (benign or malignant), small bowel obstruction that fails to resolve with conservative management, ischemic or perforated segments, complicated Meckel’s diverticulum, and trauma.
Three approaches exist. Open surgery is used for hostile abdomens with dense adhesions or in emergencies where time is of the essence. Laparoscopic procedures use small incisions with intracorporeal or extracorporeal anastomoses. The robotic approach is increasingly used for elective cases — particularly Crohn’s disease — where the wristed instruments and magnified view help with precise dissection in inflamed tissue and with the suturing required for the anastomosis.
Hospital stay is typically three to five days for elective minimally invasive cases; longer stays are common for emergent surgery, contaminated cases, or open approaches. Recovery focuses on the return of normal bowel function and a graduated diet, with activity restrictions for four to six weeks.
A mediport (also called an implanted venous access port) is a small, coin-sized reservoir placed under the skin — almost always on the upper chest just below the collarbone — and connected by a soft catheter to a large central vein. The port allows repeated IV access for medications and blood draws without repeated needle sticks in the small veins of the arms.
Ports are placed for chemotherapy delivery, long-term IV antibiotics, repeated transfusions, long-term nutrition (TPN), and for any patient with poor peripheral venous access who needs frequent labs or infusions. They are most commonly placed in cancer patients at the start of chemotherapy.
The operation is short and is performed under local anesthesia with IV sedation in most cases, though general anesthesia is sometimes used. The surgeon makes a small incision over the chest, accesses a central vein (commonly the internal jugular or subclavian, often with ultrasound guidance), advances the catheter to the superior vena cava (the large vein returning blood to the heart), and tunnels it to a pocket under the skin where the port is anchored. The position is confirmed with fluoroscopy before the incision is closed.
The procedure is outpatient. The port can be used within 24 hours if needed and stays in place for months to years, depending on how long the patient needs it. Lifting and arm activity are restricted for about five days while the incision heals.
A staging or diagnostic laparoscopy is a short, minimally invasive operation in which the surgeon inserts a small camera (a laparoscope) and instruments through tiny abdominal incisions to examine the abdominal cavity. The purpose is to confirm a diagnosis, assess the extent of disease, or take a tissue biopsy that imaging cannot provide.
The most common use is cancer staging. CT and MRI are excellent at finding most disease, but they can miss small peritoneal deposits (cancer that has spread to the lining of the abdominal cavity) and small lesions on the surface of the liver. Staging laparoscopy is used selectively for pancreatic, gastric, hepatobiliary, and ovarian cancers when the risk of radiographically occult spread is high enough to change management. Published series from high-volume centers have found that a meaningful share of pancreatic cancer patients have metastatic disease discovered at staging laparoscopy that was missed on imaging. Finding that disease before a major operation can spare patients an unnecessary surgery.
Other uses include the evaluation of unexplained abdominal pain or ascites, biopsy of intra-abdominal masses that are difficult to reach percutaneously, and assessment of trauma or chronic conditions when imaging is inconclusive.
The operation is done under general anesthesia. The abdomen is gently insufflated with CO2 gas to create working space, the laparoscope is placed (commonly through the belly button), and one or two additional small ports are placed for instruments. The surgeon inspects the peritoneal surfaces, the liver, and any suspicious lesions, and can obtain biopsies and peritoneal washings as needed.
Most staging or diagnostic laparoscopies are performed on an outpatient basis. Most patients go home the same day, once the anesthesia wears off and they can walk. Recovery typically takes a few days.
A feeding tube is a soft tube placed directly into the stomach (a gastrostomy or G-tube), into the jejunum of the small intestine (a jejunostomy or J-tube), or into both (a G-J tube). The tube delivers nutrition, fluids, and medications for patients who cannot eat enough by mouth.
Feeding tubes are used for patients with head and neck cancer or upper GI cancer who cannot swallow safely; for stroke patients and others with neurologic problems that impair swallowing; after major upper GI or esophageal surgery, where a temporary tube protects the new connection while it heals; in cases of severe malnutrition where oral intake is inadequate or unsafe; and in chronic small bowel obstruction, where venting through a tube relieves symptoms.
Three placement techniques are used:
Jejunostomy may be chosen when gastric feeding is not appropriate, including after certain upper GI operations or when reflux risk is a concern, although post-pyloric feeding does not eliminate aspiration risk.
The procedure is performed on an outpatient basis or with a single overnight observation for elective endoscopic placement. Surgical placement is performed during a larger operation and follows the recovery of that parent operation. Tube feeding usually starts within 24 hours.
