Purpose: Complex abdominal wall hernias (CAWH) present significant surgical and peri-operative challenges, particularly in populations with high comorbidity burden. Multidisciplinary team (MDT) models have been shown internationally to improve patient optimisation and operative planning, yet Australian data remains limited. This study describes the implementation of a dedicated CAWH MDT in a South Australian hospital and reports preliminary outcomes from its first year. Methodology: A retrospective cohort study was conducted of all patients discussed at the CAWH MDT at the Lyell McEwin Hospital between May 2024 and May 2025. Demographic data, hernia characteristics, comorbidities, MDT recommendations, and operative plans were prospectively recorded. Clinical outcomes were obtained through electronic medical records. For patients undergoing operative repair, concordance between MDT recommendations and operative management was assessed and categorised as full, partial, or non-concordant. Results: 71 patients were discussed across 11 MDT meetings. The mean age was 61.6 years and mean BMI was 37.5 kg/m², with 32.3% of patients having a BMI >40 kg/m². Incisional hernias accounted for 83.1% of cases, and 30.5% had undergone previous mesh repair. Following MDT review, 52 patients (73.2%) were recommended for operative management, while others were directed toward optimisation strategies including weight loss (63.4%), smoking cessation (26.8%), and pre-operative botulinum toxin (46.5%). Seventeen patients proceeded to surgery during the study period. Of these, 10 (58.8%) were fully concordant and three (17.6%) partially concordant with MDT recommendations, yielding an overall concordance rate of 76.4%. Conclusion: Establishing a structured CAWH MDT is feasible in an Australian tertiary setting and achieves high concordance between multidisciplinary planning and operative management. Early experience suggests MDT review supports patient optimisation, consistent decision-making, and safe delivery of complex abdominal wall reconstruction.