Abdominal Wall Reconstruction
- 16 November 2009
- journal article
- research article
- Published by American Medical Association (AMA)
- Vol. 144 (11), 1047-1055
- https://doi.org/10.1001/archsurg.2009.192
Abstract
Objectives To determine the efficacy and describe the evolution of the “components separation” technique for abdominal wall repair in 200 consecutive patients. Design Retrospective medical record review. Setting Northwestern Memorial Hospital, Chicago, Illinois. Patients Two hundred consecutive patients who underwent ventral hernia repair using the components separation technique. Interventions Biological and permanent meshes were used in select patients to augment the repair of the midline fascial closure but were not used as “bridging” materials. Main Outcome Measures Hernia recurrence rates and major and minor complication rates for the overall series and for the different techniques. Results Primary components separation (n = 158) yielded a 22.8% recurrence rate. Closure of the midline tissues with augmentation of the repair using an acellular cadaveric dermis underlay (n = 18) had a 33.3% recurrence rate requiring a second operation, whereas intra-abdominal soft polypropylene mesh (n = 18) had 0% recurrence (P = .04). Elevated body mass index was a significant risk factor predicting hernia recurrence (P = .003). Contamination (P = .04) and enterocutaneous fistula (P = .02) at the time of surgery were associated with increased major complications, whereas body mass index (P = .01) and diabetes mellitus (P = .04) were associated with increased minor complications. Conclusions Large complex hernias can be reliably repaired using the components separation technique despite the presence of open wounds, the need for bowel surgery, and numerous comorbidities. The long-term strength of the hernia repair is not augmented by acellular cadaveric dermis but seems to be improved with soft polypropylene mesh.Keywords
This publication has 28 references indexed in Scilit:
- The radiaL forearm fLap: a VersaTiLe meThod for inTra-oraL reconsTrUcTion 1983Published by Informa UK Limited ,2014
- Long-term Follow-up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional HerniaAnnals of Surgery, 2004
- Restoring Abdominal Wall Integrity in Contaminated Tissue-Deficient Wounds Using Autologous Fascia GraftsPlastic and Reconstructive Surgery, 2004
- Unacceptable results of the Mayo procedure for repair of abdominal incisional herniasBritish Journal of Surgery, 2003
- A Comparison of Suture Repair with Mesh Repair for Incisional HerniaNew England Journal of Medicine, 2000
- Factors Affecting Recurrence following Incisional HerniorrhaphyWorld Journal of Surgery, 2000
- Long-term Complications Associated With Prosthetic Repair of Incisional HerniasArchives of Surgery, 1998
- Recent Trends in the Management of Incisional HerniationArchives of Surgery, 1989
- Repairs in the Lower Abdomen, Groin, or Perineum with Myocutaneous or Omental FlapsPlastic and Reconstructive Surgery, 1979
- The Tensor Fascia Lata Musculocutaneous FlapAnnals of Plastic Surgery, 1978