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Giordano S, Garvey PB, Mericli A, Baumann DP, Liu J, Butler CE. Component Separation Decreases Hernia Recurrence Rates in Abdominal Wall Reconstruction with Biologic Mesh. Plast Reconstr Surg 2024; 153:717-726. [PMID: 37285202 DOI: 10.1097/prs.0000000000010810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND It is not clear whether mesh-reinforced anterior component separation (CS) for abdominal wall reconstruction (AWR) results in better outcomes than mesh-reinforced primary fascial closure (PFC) without CS, particularly when acellular dermal matrix is used. The authors compared outcomes of CS versus PFC repair in AWR procedures aiming to determine whether CS results in better outcomes. METHODS This retrospective study of prospectively collected data included 461 patients who underwent AWR with acellular dermal matrix during a 10-year period at an academic cancer center. The primary endpoint was hernia recurrence; the secondary outcome was surgical-site occurrence (SSO). RESULTS A total of 322 patients (69.9%) who underwent mesh-reinforced AWR with CS (AWR-CS) and 139 (30.1%) who underwent AWR with PFC (AWR-PFC) without CS were compared. AWR-PFC repairs had a higher hernia recurrence rate than AWR-CS repairs (10.8% versus 5.3%; P = 0.002) but similar overall complication (28.8% versus 31.4%; P = 0.580) and SSO (18.7% versus 25.2%; P = 0.132) rates. CS repairs experienced significantly higher wound separation (17.7% versus 7.9%; P = 0.007), fat necrosis (8.7% versus 2.9%; P = 0.027), and seroma (5.6% versus 1.4%; P = 0.047) rates than PFC repairs. The best cutoff with respect to hernia recurrence was 7.1 cm of abdominal defect width. CONCLUSION AWR-CS repair resulted in a lower hernia recurrence rate than AWR-PFC but, despite the additional surgery, had similar SSO rates on long-term follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Salvatore Giordano
- From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center
| | - Patrick B Garvey
- From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center
| | - Alexander Mericli
- From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center
| | - Donald P Baumann
- From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center
| | - Jun Liu
- From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center
| | - Charles E Butler
- From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center
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Bustos SS, Kuruoglu D, Truty MJ, Sharaf BA. Surgical and Patient-Reported Outcomes of Open Perforator-Preserving Anterior Component Separation for Ventral Hernia Repair. J Reconstr Microsurg 2023; 39:743-750. [PMID: 37186097 DOI: 10.1055/s-0043-1768217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Abdominal wall reconstruction is challenging for surgeons and may be life altering for patients. There are scant high-quality studies on patient-reported outcomes following abdominal wall reconstruction. We assess long-term surgical and patient-reported outcomes of perforator-preserving open anterior component separation (OPP-ACS) following large ventral hernia repair. METHODS A retrospective review of patients with large ventral hernia defects who underwent OPP-ACS performed by the authors (B.A.S., M.J.T.) was conducted between 2015 and 2019. Demographics, surgical history, operative details, outcomes, and complications were extracted. A validated questionnaire, Carolinas Comfort Scale (CCS), was used to assess postoperative quality of life. RESULTS Twenty-two patients (12 males and 10 females) with a mean age and BMI of 60.9 ± 10 years and 28.9 ± 4.8 kg/m2, respectively, were included. Mean follow-up was 28.5 ± 16.3 months. All had prior abdominal surgery; 15 (68%) for abdominopelvic malignancy, 3 (14%) for previous failed hernia repair, and 8 (36%) had history of abdominopelvic radiation. Overall, 16 (73%) hernias were in the midline, 4 (18%) in the right lower quadrant, 1 (4.5%) in the right upper quadrant, and 1 (4.5%) in the left lower quadrant. Mean hernia defect surface area was 145 ± 112 cm2. A total of 9 patients (40.9%) underwent bilateral component separation, whereas 13 (59.1%) had unilateral. Bioprosthetic mesh was used in all patients as underlay. Mean mesh size and thickness were 545.6 ± 207.7 cm2 and 3.4 ± 0.5 mm, respectively. One patient presented with a minor wound dehiscence, and two presented with seromas not requiring aspiration/evacuation. One patient had hernia recurrence 22 months after surgery. One patient was readmitted for partial small bowel obstruction and one required wound revision. A total of 14 (65%) patients responded to the CCS questionnaire. At 12 months, mean score for all 23 items was 0.29 ± 0.21 (0.08-0.62), which corresponds to absence or minimal symptoms. CONCLUSION The OPP-ACS is a safe surgical option for large, complex ventral hernias. Our cases showed minimal complication rate and hernia recurrence, and our patients reported significant improvement in life quality.
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Affiliation(s)
- Samyd S Bustos
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
| | - Doga Kuruoglu
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mark J Truty
- Division of Hepato-Pancreatico-Biliary Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Basel A Sharaf
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
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Yang S, Wang MG, Nie YS, Zhao XF, Liu J. Outcomes and complications of open, laparoscopic, and hybrid giant ventral hernia repair. World J Clin Cases 2022; 10:51-61. [PMID: 35071505 PMCID: PMC8727244 DOI: 10.12998/wjcc.v10.i1.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/11/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An incisional hernia is a common complication of abdominal surgery.
AIM To evaluate the outcomes and complications of hybrid application of open and laparoscopic approaches in giant ventral hernia repair.
METHODS Medical records of patients who underwent open, laparoscopic, or hybrid surgery for a giant ventral hernia from 2006 to 2013 were retrospectively reviewed. The hernia recurrence rate and intra- and postoperative complications were calculated and recorded.
RESULTS Open, laparoscopic, and hybrid approaches were performed in 82, 94, and 132 patients, respectively. The mean hernia diameter was 13.11 ± 3.4 cm. The incidence of hernia recurrence in the hybrid procedure group was 1.3%, with a mean follow-up of 41 mo. This finding was significantly lower than that in the laparoscopic (12.3%) or open procedure groups (8.5%; P < 0.05). The incidence of intraoperative intestinal injury was 6.1%, 4.1%, and 1.5% in the open, laparoscopic, and hybrid procedures, respectively (hybrid vs open and laparoscopic procedures; P < 0.05). The proportion of postoperative intestinal fistula formation in the open, laparoscopic, and hybrid approach groups was 2.4%, 6.8%, and 3.3%, respectively (P > 0.05).
CONCLUSION A hybrid application of open and laparoscopic approaches was more effective and safer for repairing a giant ventral hernia than a single open or laparoscopic procedure.
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Affiliation(s)
- Shuo Yang
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Ming-Gang Wang
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Yu-Sheng Nie
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Xue-Fei Zhao
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Jing Liu
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
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Long-term outcomes and quality of life assessment after posterior component separation with transversus abdominis muscle release (TAR). Surg Endosc 2021; 36:1278-1283. [PMID: 33661379 DOI: 10.1007/s00464-021-08402-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although transversus abdominis release (TAR) to treat large incisional hernias has shown favorable postoperative outcomes, devastating complications may occur when it is used in suboptimal conditions. We aimed to evaluate postoperative outcomes and long-term follow-up after TAR for large incisional hernias. METHODS A consecutive series of patients undergoing TAR for complex incisional hernias between 2014 and 2019 with a minimum of 6 month follow-up was included. Demographics, operative and postoperative variables were analyzed. Postoperative imaging (CT-scan) was also evaluated to detect occult recurrences. The HerQLes survey for quality of life (QoL) assessment was performed preoperatively and 6 months after the surgery. RESULTS A total of 50 TAR repairs were performed. Mean age was 65 (35-83) years, BMI was 28.5 ± 3.4 kg/m2, and 8 (16%) patients had diabetes. Mean Tanaka index was 14.2 ± 8.5. Mean defect area was 420 (100-720) cm2, average defect width was 19 ± 6.2 cm, and mesh area was 900 (500-1050) cm2; 78% were clean procedures, and in 60% a panniculectomy was associated. Operative time was 252 (162-438) minutes, and hospital stay was 4.5 (2-16) days. Thirty-day morbidity was 24% (12 patients), and 16% (8 patients) had surgical site infections. Overall recurrence rate was 4% (2 patients) after 28.2 ± 20.1 months of follow-up. QoL showed a significant improvement after surgery (p = 0.001). CONCLUSIONS The TAR technique is an effective treatment modality for large incisional hernias, showing an acceptable postoperative morbidity, a significant improvement in QoL, and low recurrence rates at long-term follow-up.
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Minimally invasive component separation technique for large ventral hernia: which is the best choice? A systematic literature review. Surg Endosc 2019; 34:14-30. [PMID: 31586250 DOI: 10.1007/s00464-019-07156-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/24/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Aim of the present systematic review is to compare the postoperative outcomes after minimally invasive anterior and posterior component separation technique (CST), in terms of postoperative morbidity and recurrence rates. METHODS Nine-hundred and fifty-nine articles were identified through Pubmed database. Of these, 444 were eliminated because were duplicates between the searches. Of the remaining 515 articles, 414 were excluded after screening title and abstract. One hundred and one articles were fully analysed, and 73 articles were further excluded, finally including 28 articles. Based on the surgical technique, three groups were created: Group A, endoscopic anterior CST and closure of the abdominal midline by laparotomy; Group B, endoscopic anterior CST and closure of the abdominal midline laparoscopically or robotically; Group C, laparoscopic or robotic posterior CST with transversus abdominal muscle release (TAR). RESULTS In group A, B and C, 196, 120 and 236 patients were included, respectively. Surgical and medical complication rates for the three groups were 31.2% and 13.7% in group A, 15.8% and 4.1% in group B, and 17.8% and 25.4% in group C, while recurrence rate was 10.7%, 6.6% and 0.4%, respectively. Statistically significant differences were observed in terms of surgical postoperative complication rate between group A versus B (p = 0.0022) and between group A versus C (p = 0.0015) and of recurrence rate between group A versus C (p = < 0.0001) and B versus C (p = 0.0009). CONCLUSIONS Anterior CST with midline closure by laparotomy showed the worst results in terms of postoperative surgical complications and recurrence in comparison to the pure minimally anterior and posterior CST. Posterior CST-TAR showed lowest hospital stay and recurrence rate, although the follow-up is short. However, due to the poor quality of most of the studies, further prospective studies and randomized control trials, with wider sample size and longer follow-up are required to demonstrate which is the best surgical option.
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Peker YS, Hançerlioğulları O, Can MF, Demirbaş S. Conventional versus endoscopic components separation technique: New anthropometric calculation for selection of surgical approach. Turk J Med Sci 2019; 49:1109-1116. [PMID: 31385485 PMCID: PMC7018229 DOI: 10.3906/sag-1708-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim Giant ventral incisional hernias (GVIHs) are hard to manage for surgeons. This problem was resolved in 1990 with the components separation technique (CST). We aimed to compare endoscopic and conventional CST for GVIHs and find a new anthropometric calculation. Materials and methods In this prospective nonrandomized clinical trial, 21 patients were treated with endoscopic or conventional CST between 2012 and 2016. Eight patients (38.1%) were operated endoscopically and 13 (61.9%) conventionally on the basis of preoperative tomography results, hernia surface area (HSA), number of recent abdominal operations, comorbidities, and the presence or history of ostomy. Groups in which prosthetic material was applied were also compared with groups in which it was not. Results There was no statistically significant difference between endoscopic and conventional CST groups in terms of complications. A weakly statistically significant difference (P = 0.069) was found between the components separation index (CSI) of mesh-applied and not-applied patients. HSA/body surface area (BSA) was statistically significantly different between endoscopic and conventional CST groups. Conclusion According to our results, HSA/BSA and CSI are statistically successful for preoperative prediction of mesh placement. Furthermore, HSA/BSA preoperatively successfully predicts whether conventional or endoscopic CST should be used in patients with GVIH.
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Affiliation(s)
- Yaşar Subutay Peker
- Department of General Surgery, Gülhane Training and Research Hospital, University of Medical Sciences, Ankara, Turkey
| | - Oğuz Hançerlioğulları
- Department of General Surgery, Gülhane Training and Research Hospital, University of Medical Sciences, Ankara, Turkey
| | - Mehmet Fatih Can
- Department of General Surgery, Gülhane Training and Research Hospital, University of Medical Sciences, Ankara, Turkey
| | - Sezai Demirbaş
- Department of General Surgery, TOBB ETÜ University Hospital, Ankara, Turkey
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Abstract
In the field of hernia surgery, there have been many advances in techniques that have provided the surgeon with a variety of options to repair the difficult abdominal wall hernia. Regardless of the technique, the ultimate goal was to provide a tension-free repair, which attempts to approximate the midline while returning abdominal wall musculature to its normal anatomic position, thus providing the patient with both a cosmetic and durable result with or without the use of a prosthetic reinforcement. Component separation techniques have been widely popularized as techniques to repair complex hernias and are frequently categorized based upon the anatomic location of the myofascial release. CSTs are generally categorized as either an anterior component separation or posterior component separation based upon the surgical approach to the abdominal wall musculature. This report objectively outlines the various techniques of component separation and specifically compares the outcomes among techniques to facilitate decision making in abdominal wall reconstruction.
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Yuan Y, Zuo J, Dai W, Feng W, Xiong W, Tan J, Tan M. Deperitoneum biological mesh repair for abdominal wall hernia: a novel wound healing promotion idea. MINIM INVASIV THER 2018; 28:143-150. [PMID: 30307355 DOI: 10.1080/13645706.2018.1481093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Nowadays, biological matrix has become more widely applied than synthetic mesh for the surgical management of ventral hernia. Conventionally, such biodegradable matrix is commonly placed in an intraperitoneal or extraperitoneal position to reinforce the abdominal wall during surgery. Herein, we introduce our novel idea to deliver such biological material. MATERIAL AND METHODS After contrast-enhanced CT-scan via lateral decubitus confirmed the position of ventral hernias, 11 patients underwent deperitoneum biological mesh repair by open or laparoscopic approach. During surgery, biological material was placed in preperitoneal position with elimination of matrix-covered peritoneum meanwhile. No bridge repair was allowed for this technique. Postoperative complications were prospectively documented. RESULTS Laparoscopic and open repair were performed in six and five patients, respectively. The mean operative time was 115 min, with no significant difference between the two procedures. All patients had quick recovery and returned to their normal life, with median five days (range, 3-12 days) of hospital stay after surgery. Although wound dehiscence and chronic pain occurred in three (27.3%) patients, no additional surgery was required. No recurrence case was observed within the one-year follow-up period. CONCLUSION This novel approach could be safely performed in ventral hernia patients. Early evaluation of this surgical technique demonstrates quick recovery and minimal complications.
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Affiliation(s)
- Yujie Yuan
- a Center of Gastrointestinal Surgery, The First Affiliated Hospital , Sun Yat-Sen University , Guangzhou , 510080 , P.R. China
| | - Jidong Zuo
- a Center of Gastrointestinal Surgery, The First Affiliated Hospital , Sun Yat-Sen University , Guangzhou , 510080 , P.R. China
| | - Weigang Dai
- a Center of Gastrointestinal Surgery, The First Affiliated Hospital , Sun Yat-Sen University , Guangzhou , 510080 , P.R. China
| | - Weidong Feng
- a Center of Gastrointestinal Surgery, The First Affiliated Hospital , Sun Yat-Sen University , Guangzhou , 510080 , P.R. China
| | - Weixin Xiong
- a Center of Gastrointestinal Surgery, The First Affiliated Hospital , Sun Yat-Sen University , Guangzhou , 510080 , P.R. China
| | - Jinfu Tan
- a Center of Gastrointestinal Surgery, The First Affiliated Hospital , Sun Yat-Sen University , Guangzhou , 510080 , P.R. China
| | - Min Tan
- a Center of Gastrointestinal Surgery, The First Affiliated Hospital , Sun Yat-Sen University , Guangzhou , 510080 , P.R. China
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Halligan S, Parker SG, Plumb AAO, Wood CPJ, Bolton RW, Mallett S, Windsor ACJ. Use of imaging for pre- and post-operative characterisation of ventral hernia: systematic review. Br J Radiol 2018; 91:20170954. [PMID: 29485893 PMCID: PMC6223174 DOI: 10.1259/bjr.20170954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Complex ventral hernia (CVH) repair is performed increasingly, exacerbated by the obesity epidemic. Imaging can characterise hernia morphology and diagnose recurrence. By systematic review we investigated the extent to which studies employ imaging. METHODS The PubMed database was searched for studies of ventral hernia repair from January 1995 to March 2016. Hernias of all size were eligible. Independent reviewers screened articles and extracted data from selected studies related to study design, use of pre- and post-operative hernia imaging and the proportion of subjects imaged. The review was registered: PROSPERO CRD42016043071. RESULTS 15,771 records were identified initially. 174 full-texts were examined and 158 ultimately included in the systematic review [31 randomised controlled trials (RCTs); 32 cohort studies; 95 retrospective cohort studies]. 31,874 subjects were reported overall. Only 19 (12%) studies employed pre-operative imaging for hernia characterisation and 46 (29%) post-operatively [equating to 511 (2%) of all pre-operative subjects and 1123 (4%) post-operative]. Furthermore, most studies employing imaging did not do so in all subjects: Just 6 (4%) of the 158 studies used imaging in all subjects pre-operatively and just 4 (3%) post-operatively, i.e. imaging was usually applied to a proportion of patients only. Moreover, the exact proportion was frequently not specified. Studies using imaging frequently stated that "imaging", "radiography" or "radiology" was used but did not specify the modality precisely nor the proportion of subjects imaged. CONCLUSION Despite the ability to characterise ventral hernia morphology and recurrence with precision, most indexed studies do not employ imaging. Where imaging is used, data are often reported incompletely. Advances in knowledge: (1) This systematic review is the first to focus on the use of imaging in surgical studies of ventral hernia repair. (2) Studies of ventral hernia repair rarely use imaging, either to characterise hernias pre-operatively or to diagnose recurrence, despite the latter being the primary outcome of most studies. (3) Failure to use imaging will result in incomplete hernia characterisation and underestimate recurrence rates in studies of surgical repair.
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Affiliation(s)
- Steve Halligan
- Centre for
Medical Imaging, University College London, Charles Bell
House, London, UK
| | - Sam G Parker
- Department
of Surgery, The Abdominal Wall Unit, University College
Hospital, London,
UK
| | - Andrew A O Plumb
- Centre for
Medical Imaging, University College London, Charles Bell
House, London, UK
| | - Chris PJ Wood
- Department
of Surgery, The Abdominal Wall Unit, University College
Hospital, London,
UK
| | - Richard W Bolton
- Department
of Surgery, The Abdominal Wall Unit, University College
Hospital, London,
UK
| | - Susan Mallett
- Institute of
Applied Health Sciences, University of Birmingham,
Edgbaston, UK
| | - Alastair CJ Windsor
- Department
of Surgery, The Abdominal Wall Unit, University College
Hospital, London,
UK
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Cornette B, De Bacquer D, Berrevoet F. Component separation technique for giant incisional hernia: A systematic review. Am J Surg 2018; 215:719-726. [DOI: 10.1016/j.amjsurg.2017.07.032] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/19/2017] [Accepted: 07/26/2017] [Indexed: 12/28/2022]
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Scheuerlein H, Thiessen A, Schug-Pass C, Köckerling F. What Do We Know About Component Separation Techniques for Abdominal Wall Hernia Repair? Front Surg 2018; 5:24. [PMID: 29637073 PMCID: PMC5881422 DOI: 10.3389/fsurg.2018.00024] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/05/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction The component separation technique (CST) was introduced to abdominal wall reconstruction to treat large, complex hernias. It is very difficult to compare the published findings because of the vast number of technical modifications to CST as well as the heterogeneity of the patient population operated on with this technique. Material and Methods The main focus of the literature search conducted up to August 2017 in Medline and PubMed was on publications reporting comparative findings as well as on systematic reviews in order to formulate statements regarding the various CSTs. Results CST without mesh should no longer be performed because of too high recurrence rates. Open anterior CST has too high a surgical site occurrence rate and henceforth should only be conducted as endoscopic and perforator sparing anterior CST. Open posterior CST and posterior CST with transversus abdominis release (TAR) produce better results than open anterior CST. To date, no significant differences have been found between endoscopic anterior, perforator sparing anterior CST and posterior CST with transversus abdominis release. Robot-assisted posterior CST with TAR is the latest, very promising alternative. The systematic use of biologic meshes cannot be recommended for CST. Conclusion CST should always be performed with mesh as endoscopic or perforator sparing anterior or posterior CST. Robot-assisted posterior CST with TAR is the latest development.
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Affiliation(s)
- Hubert Scheuerlein
- Department for General and Visceral Surgery, Vincenz Hospital, Paderborn, Germany
| | - Andreas Thiessen
- Department for General and Visceral Surgery, Vincenz Hospital, Paderborn, Germany
| | - Christine Schug-Pass
- Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital, Academic Teaching Hospital of Charité Medical School, Berlin, Germany
| | - Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital, Academic Teaching Hospital of Charité Medical School, Berlin, Germany
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How we do it: down to up posterior components separation. Langenbecks Arch Surg 2018; 403:539-546. [DOI: 10.1007/s00423-018-1655-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/22/2018] [Indexed: 10/17/2022]
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Oviedo RJ, Robertson JC, Desai AS. Robotic Ventral Hernia Repair and Endoscopic Component Separation: Outcomes. JSLS 2017; 21:JSLS.2017.00055. [PMID: 28951658 PMCID: PMC5610118 DOI: 10.4293/jsls.2017.00055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Robot-assisted hernia repair, combined with endoscopic component separation, has reduced recurrence and complication rates and allowed immediate intervention in obese patients. We sought to study surgical outcomes in this high-risk group of patients in a community hospital. METHODS We conducted a retrospective chart review of ventral, incisional, and umbilical hernia repairs performed at a small community hospital by a single surgeon from March 2014 through November 2016, with statistical analysis of the surgical outcomes. Patients included were those who underwent hernia repair during the study period and had a body mass index (BMI) >30. Patients were followed up for a minimum of 6 months (range, 6-37). RESULTS Forty-seven hernia repairs were performed, including 33 combined and 14 control cases. The demographics of each group were comparable when comparing sex, age, BMI, and ASA classification. Mean follow-up was 19.39 months in the study group and 28.64 months in the control group. There were no significant differences in total operative time, estimated blood loss, conversion rates, or hospital length of stay. Two complications occurred in each of the study and control groups, with no recurrences in the study group and 3 in the control group and no mortalities. CONCLUSION Robotic laparoscopic repair of abdominal wall defects offers significant advantages, including easier primary defect closure. Our analyses showed that combining robot-assisted hernia repair with mesh and endoscopic component separation is an effective intervention in obese patients.
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Affiliation(s)
- Rodolfo J Oviedo
- Department of Surgery, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Jarrod C Robertson
- Department of Surgery, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Apurva Sunder Desai
- University Department of Statistics, Florida State University, Tallahassee, Florida, USA
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Holihan JL, Alawadi ZM, Harris JW, Harvin J, Shah SK, Goodenough CJ, Kao LS, Liang MK, Roth JS, Walker PA, Ko TC. Ventral hernia: Patient selection, treatment, and management. Curr Probl Surg 2016; 53:307-54. [DOI: 10.1067/j.cpsurg.2016.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/14/2016] [Indexed: 12/14/2022]
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How to perform the endoscopically assisted components separation technique (ECST) for large ventral hernia repair. Hernia 2016; 20:441-7. [DOI: 10.1007/s10029-016-1485-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
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Desai NK, Leitman IM, Mills C, Lavarias V, Lucido DL, Karpeh MS. Open repair of large abdominal wall hernias with and without components separation; an analysis from the ACS-NSQIP database. Ann Med Surg (Lond) 2016; 7:14-9. [PMID: 27158489 PMCID: PMC4843100 DOI: 10.1016/j.amsu.2016.02.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 02/27/2016] [Accepted: 02/28/2016] [Indexed: 11/29/2022] Open
Abstract
Background Components separation technique emerged several years ago as a novel procedure to improve durability of repair for ventral abdominal hernias. Almost twenty-five years since its initial description, little comprehensive risk adjusted data exists on the morbidity of this procedure. This study is the largest analysis to date of short-term outcomes for these cases. Methods The ACS-NSQIP database identified open ventral or incisional hernia repairs with components separation from 2005 to 2012. A data set of cohorts without this technique, matched for preoperative risk factors and operative characteristics, was developed for comparison. A comprehensive risk-adjusted analysis of outcomes and morbidity was performed. Results A total of 68,439 patients underwent open ventral hernia repair during the study period (2245 with components separation performed (3.3%) and 66,194 without). In comparison with risk-adjusted controls, use of components separation increased operative duration (additional 83 min), length of stay (6.4 days vs. 3.8 days, p < 0.001), return to the OR rate (5.9% vs. 3.6%, p < 0.001), and 30-day morbidity (10.1% vs. 7.6%, p < 0.001) with no increase in mortality (0.0% in each group). Conclusions Components separation technique for large incisional hernias significantly increases length of stay and postoperative morbidity. Novel strategies to improve short-term outcomes are needed with continued use of this technique. The repair of large abdominal wall hernias is more frequently performed using components separation. While this technique appears to reduce recurrence, morbidity has not been previously studied. When compared to a large cohort, components separation has a higher complication rate than traditional open hernia repair.
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Affiliation(s)
- Nirav K Desai
- Department of Surgery, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - I Michael Leitman
- Department of Surgery, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher Mills
- Department of Surgery, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Valentina Lavarias
- Department of Surgery, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David L Lucido
- Department of Surgery, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martin S Karpeh
- Department of Surgery, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Jensen KK, Brondum TL, Harling H, Kehlet H, Jorgensen LN. Enhanced recovery after giant ventral hernia repair. Hernia 2016; 20:249-56. [PMID: 26910800 DOI: 10.1007/s10029-016-1471-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Giant ventral hernia repair is associated with a high risk of postoperative morbidity and prolonged length of stay (LOS). Enhanced recovery (ERAS) measures have proved to lead to decreased morbidity and LOS after various surgical procedures, but never after giant hernia repair. The current study prospectively examined the results of implementation of an ERAS pathway including high-dose preoperative glucocorticoid, and compared the outcome with patients previously treated according to standard care (SC). METHODS Consecutive patients who underwent giant ventral hernia repair were included. Pain, nausea and fatigue were registered prospectively in all patients treated according to ERAS, as well as continuous measurement of transcutaneous capillary oxygen saturation. Postoperative morbidity and LOS were compared between patients treated according to ERAS and a historic group treated with SC. RESULTS A total of 32 patients were included. Postoperative LOS was decreased after the introduction of the ERAS pathway compared with SC (median 3.0 vs. 5.5 days, P = 0.003). Scores of pain, nausea and fatigue were low, while mean oxygen saturation during the first three postoperative days was 0.92. There were no differences when comparing readmission (5 vs. 2, P = 0.394), postoperative complications (7 vs. 4, P = 0. 458), or reoperation (5 vs. 1, P = 0.172) in ERAS versus controls. CONCLUSIONS The current study suggests that an ERAS pathway including preoperative high-dose glucocorticoid may lead to low scores of pain, fatigue and nausea after giant ventral hernia repair with reduced LOS compared with patients treated according to SC.
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Affiliation(s)
- K K Jensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| | - T L Brondum
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
| | - H Harling
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
| | - H Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - L N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
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21
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van Walraven C, McAlister FA. Competing risk bias was common in Kaplan–Meier risk estimates published in prominent medical journals. J Clin Epidemiol 2016; 69:170-3.e8. [DOI: 10.1016/j.jclinepi.2015.07.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/26/2015] [Accepted: 07/20/2015] [Indexed: 02/07/2023]
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Vorst AL, Kaoutzanis C, Carbonell AM, Franz MG. Evolution and advances in laparoscopic ventral and incisional hernia repair. World J Gastrointest Surg 2015; 7:293-305. [PMID: 26649152 PMCID: PMC4663383 DOI: 10.4240/wjgs.v7.i11.293] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/19/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Primary ventral hernias and ventral incisional hernias have been a challenge for surgeons throughout the ages. In the current era, incisional hernias have increased in prevalence due to the very high number of laparotomies performed in the 20th century. Even though minimally invasive surgery and hernia repair have evolved rapidly, general surgeons have yet to develop the ideal, standardized method that adequately decreases common postoperative complications, such as wound failure, hernia recurrence and pain. The evolution of laparoscopy and ventral hernia repair will be reviewed, from the rectoscopy of the 4th century to the advent of laparoscopy, from suture repair to the evolution of mesh reinforcement. The nuances of minimally invasive ventral and incisional hernia repair will be summarized, from preoperative considerations to variations in intraoperative practice. New techniques have become increasingly popular, such as primary defect closure, retrorectus mesh placement, and concomitant component separation. The advent of robotics has made some of these repairs more feasible, but only time and well-designed clinical studies will tell if this will be a durable modality for ventral and incisional hernia repair.
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Holihan JL, Askenasy EP, Greenberg JA, Keith JN, Martindale RG, Roth JS, Mo J, Ko TC, Kao LS, Liang MK. Component Separation vs. Bridged Repair for Large Ventral Hernias: A Multi-Institutional Risk-Adjusted Comparison, Systematic Review, and Meta-Analysis. Surg Infect (Larchmt) 2015; 17:17-26. [PMID: 26375422 DOI: 10.1089/sur.2015.124] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Repair of large ventral hernia defects is associated with high rates of surgical site occurrences (SSO), including surgical site infection (SSI), site dehiscence, seroma, hematoma, and site necrosis. Two common operative strategies exist: Component separation (CS) with primary fascial closure and mesh reinforcement (PFC-CS) and bridged repair (mesh spanning the hernia defect). We hypothesized that: (1) ventral hernia repair (VHR) of large defects with bridged repair is associated with more SSOs than is PFC, and (2) anterior CS is associated with more SSOs than is endoscopic, perforator-sparing, or posterior CS. METHODS Part I of this study was a review of a multi-center database of patients who underwent VHR of a defect ≥8 cm from 2010-2011 with at least one month of follow-up. The primary outcome was SSO. The secondary outcome was recurrence. Part II of this study was a systematic review and meta-analysis of studies comparing bridged repair with PFC and studies comparing different kinds of CS. RESULTS A total of 108 patients were followed for a median of 16 months (range 1-50 months), of whom 84 underwent PFC-CS and 24 had bridged repairs. Unadjusted results demonstrated no differences between the groups in SSO or recurrence; however, the study was underpowered for this purpose. On meta-analysis, PFC was associated with a lower risk of SSO (odds ratio [OR] = 0.569; 95% confidence interval [CI] = 0.34-0.94) and recurrence (OR = 0.138; 95% CI = 0.08-0.23) compared with bridged repair. On multiple-treatments meta-analysis, both endoscopic and perforator-sparing CS were most likely to be the treatments with the lowest risk of SSO and recurrence. CONCLUSIONS Bridged repair was associated with more SSOs than was PFC, and PFC should be used whenever feasible. Endoscopic and perforator-sparing CS were associated with the fewest complications; however, these conclusions are limited by heterogeneity between studies and poor methodological quality. These results should be used to guide future trials, which should compare the risks and benefits of each CS method to determine in which setting each technique will give the best results.
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Affiliation(s)
- Julie L Holihan
- 1 Department of Surgery, The University of Texas Health Science Center at Houston , Houston, Texas
| | - Eric P Askenasy
- 2 Department of Surgery, Baylor College of Medicine , Houston, Texas
| | - Jacob A Greenberg
- 3 Department of Surgery, University of Wisconsin , Madison, Wisconsin
| | - Jerrod N Keith
- 4 Department of Plastic Surgery, University of Iowa , Iowa City, Iowa
| | - Robert G Martindale
- 5 Department of Surgery, Oregon Health and Science University , Portland, Oregon
| | - J Scott Roth
- 6 Department of Surgery, University of Kentucky , Lexington, Kentucky
| | - Jiandi Mo
- 1 Department of Surgery, The University of Texas Health Science Center at Houston , Houston, Texas
| | - Tien C Ko
- 1 Department of Surgery, The University of Texas Health Science Center at Houston , Houston, Texas
| | - Lillian S Kao
- 1 Department of Surgery, The University of Texas Health Science Center at Houston , Houston, Texas
| | - Mike K Liang
- 1 Department of Surgery, The University of Texas Health Science Center at Houston , Houston, Texas
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Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature. Surg Today 2015. [DOI: 10.1007/s00595-015-1219-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ng N, Wampler M, Palladino H, Agullo F, Davis BR. Outcomes of Laparoscopic versus Open Fascial Component Separation for Complex Ventral Hernia Repair. Am Surg 2015. [DOI: 10.1177/000313481508100722] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ventral hernia recurrence rates have improved with advancements in technique. Open and laparoscopic fascial component separation techniques improve recurrence rates by allowing a tension free closure. This study examines laparoscopic component separation (LCS) and open component separation (OCS) techniques in the repair of complex ventral hernias and compares factors affecting patient outcomes. A retrospective chart review of patients who underwent ventral hernia repair with LCS and OCS was conducted between 2009 and 2013. Patient characteristics and outcomes were documented. Hernia recurrence was determined using physical exam and computed tomography if physical exam was equivocal. Univariate and multivariate analyses were performed. Ten patients underwent LCS and 38 underwent OCS. The rate of wound infection in the LCS group was 20 per cent versus 50 per cent in the OCS group. The overall rate of recurrence after LCS was 20 per cent, and 26 per cent in the OCS group. For body mass index > 30, the recurrence rate was 20 per cent in the LCS group and 29 per cent ( P = 0.5) in the open group. The use of LCS demonstrates a trend in the reduction of hernia recurrence and wound infection overall and in patients with body mass index > 30 compared with OCS.
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Affiliation(s)
- Nathaniel Ng
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Mallory Wampler
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Humberto Palladino
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Francisco Agullo
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Brian R. Davis
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, Texas
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Minimally Invasive Component Separation Techniques in Complex Ventral Abdominal Hernia Repair. Surg Laparosc Endosc Percutan Tech 2015; 25:100-5. [DOI: 10.1097/sle.0000000000000114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jensen KK, Henriksen NA, Jorgensen LN. Endoscopic component separation for ventral hernia causes fewer wound complications compared to open components separation: a systematic review and meta-analysis. Surg Endosc 2014; 28:3046-52. [DOI: 10.1007/s00464-014-3599-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/06/2014] [Indexed: 01/09/2023]
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