Components Separation for Abdominal Wall Reconstruction in the Recalcitrant, High-Comorbidity Patient: A Review of 311 Single-Surgeon Cases

A Variation of the Components’ Separation Technique that Preserves the Semilunaris for Treatment of Abdominal Wall Deformities

The variation of the components’ separation technique, which uses the anterior rectus sheath and the release of the oblique muscles, proved to be effective in tension reduction. This paper aimed to present the initial experience using a variation that preserves semilunaris through the incision of the lateral aspect of the rectus sheath. All of the 12 patients presented an abdominal wall defect that included incisional hernia, peritoneostomy, lateral implantation of the rectus muscle, and defect secondary to TRAM flap. The separation was done in the following stages: stage 1—anterior rectus sheath and stage 2—external oblique muscles. From the 12 patients, three presented early complications: seroma (n = 2) and epitheliolysis (n = 1). There were no recurrences or other late complications (48 months follow-up period). The separation of the anterior rectus sheath, and incision in the lateral recess to undermine the oblique muscles, allowed the treatment of abdominal wall defects, without late complications.

Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

AIM

To analyze the outcomes of component separation techniques (CST) to treat incisional hernias (IH) in a large multicenter cohort of patients.

METHODS

All IH repair using CST, registered in EVEREG from July 2012 to December 2019, were included. Data on the pre-operative patient characteristics and comorbidities, IH characteristics, surgical technique, complications, and recurrence were collected. Outcomes between anterior (ACS) and posterior component separation (PCS) techniques were compared. Risk factors for complications and recurrences were analyzed.

RESULTS

During the study period, 1536 patients underwent CST (45.5% females) with a median age of 64.0 years and median body mass index (BMI) of 29.7 kg/m². ACS was the most common technique (77.7%). Overall complications were frequent in both ACS and PCS techniques (36.5%), with a higher frequency of wound infection (10.6% vs. 7.0%; P = 0.05) and skin necrosis (4.4% vs. 0.1%; P < 0.0001) with the ACS technique. Main factors leading to major complications were mesh explant (OR 1.72; P = 0.001), previous repair (OR 0.75; P = 0.038), morbid obesity (OR 0.67; P = 0.015), ASA grade (OR 0.62; P < 0.0001), COPD (OR 0.52; P < 0.0001), and longitudinal diameter larger than 10 cm (OR 0.58; P = 0.001). After a minimum follow-up of 6 months (median 15 months; N = 590), 59 (10.0%) recurrences were diagnosed. Operations performed in a non-specialized unit were significantly associated with recurrences (HR 4.903, CI 1.64-14.65; P = 0.004).

CONCLUSION

CST is a complex procedure with a high rate of complications. Both ACS and PCS techniques have similar complication and recurrence rates. Operations performed in a specialized unit have better outcomes.