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J Reconstr Microsurg 2023; 39(09): 743-750
DOI: 10.1055/s-0043-1768217
Original Article

Surgical and Patient-Reported Outcomes of Open Perforator-Preserving Anterior Component Separation for Ventral Hernia Repair

Samyd S. Bustos
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
,
Doga Kuruoglu 
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
,
Mark J. Truty
2   Division of Hepato-Pancreatico-Biliary Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
,
Basel A. Sharaf
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
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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.

Keywords

ventral hernia - component separation - perforator


Publikationsverlauf

Eingereicht: 06. September 2022

Angenommen: 28. Februar 2023

Artikel online veröffentlicht:
26. April 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Funk LM, Perry KA, Narula VK, Mikami DJ, Melvin WS. Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States. Surg Endosc 2013; 27 (11) 4104-4112
    CrossrefPubMedSuche in Google Scholar
  • 2 Holihan JL, Alawadi Z, Martindale RG. et al. Adverse events after ventral hernia repair: the vicious cycle of complications. J Am Coll Surg 2015; 221 (02) 478-485
    CrossrefPubMedSuche in Google Scholar
  • 3 Holihan JL, Askenasy EP, Greenberg JA. et al; Ventral Hernia Outcome Collaboration Writing Group. Component separation vs. bridged repair for large ventral hernias: a multi-institutional risk-adjusted comparison, systematic review, and meta-analysis. Surg Infect (Larchmt) 2016; 17 (01) 17-26
    CrossrefPubMedSuche in Google Scholar
  • 4 Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 2003; 237 (01) 129-135
    CrossrefPubMedSuche in Google Scholar
  • 5 Mathes SJ, Steinwald PM, Foster RD, Hoffman WY, Anthony JP. Complex abdominal wall reconstruction: a comparison of flap and mesh closure. Ann Surg 2000; 232 (04) 586-596
    CrossrefPubMedSuche in Google Scholar
  • 6 Leppäniemi A, Tukiainen E. Reconstruction of complex abdominal wall defects. Scand J Surg 2013; 102 (01) 14-19
    CrossrefPubMedSuche in Google Scholar
  • 7 Sosin M, Patel KM, Albino FP, Nahabedian MY, Bhanot P. A patient-centered appraisal of outcomes following abdominal wall reconstruction: a systematic review of the current literature. Plast Reconstr Surg 2014; 133 (02) 408-418
    CrossrefPubMedSuche in Google Scholar
  • 8 Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 1990; 86 (03) 519-526
    CrossrefPubMedSuche in Google Scholar
  • 9 Saulis AS, Dumanian GA. Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs. Plast Reconstr Surg 2002; 109 (07) 2275-2280 , discussion 2281–2282
    CrossrefPubMedSuche in Google Scholar
  • 10 Fox M, Cannon RM, Egger M, Spate K, Kehdy FJ. Laparoscopic component separation reduces postoperative wound complications but does not alter recurrence rates in complex hernia repairs. Am J Surg 2013; 206 (06) 869-874 , discussion 874–875
    CrossrefPubMedSuche in Google Scholar
  • 11 Carbonell AM, Cobb WS, Chen SM. Posterior components separation during retromuscular hernia repair. Hernia 2008; 12 (04) 359-362
    CrossrefPubMedSuche in Google Scholar
  • 12 Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 2012; 204 (05) 709-716
    CrossrefPubMedSuche in Google Scholar
  • 13 Ghali S, Turza KC, Baumann DP, Butler CE. Minimally invasive component separation results in fewer wound-healing complications than open component separation for large ventral hernia repairs. J Am Coll Surg 2012; 214 (06) 981-989
    CrossrefPubMedSuche in Google Scholar
  • 14 Dumanian GA. Open Anterior Component Separation with Perforator Preservation. In: Hernia Surgery. Cham: Springer International Publishing; 2016: 159-168
    Suche in Google Scholar
  • 15 Heniford BT, Lincourt AE, Walters AL. et al. Carolinas Comfort Scale as a measure of hernia repair quality of life: a reappraisal utilizing 3788 international patients. Ann Surg 2018; 267 (01) 171-176
    CrossrefPubMedSuche in Google Scholar
  • 16 Butler CE, Campbell KT. Minimally invasive component separation with inlay bioprosthetic mesh (MICSIB) for complex abdominal wall reconstruction. Plast Reconstr Surg 2011; 128 (03) 698-709
    CrossrefPubMedSuche in Google Scholar
  • 17 Clemens MW, Selber JC, Liu J. et al. Bovine versus porcine acellular dermal matrix for complex abdominal wall reconstruction. Plast Reconstr Surg 2013; 131 (01) 71-79
    CrossrefPubMedSuche in Google Scholar
  • 18 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
    CrossrefPubMedSuche in Google Scholar
  • 19 Liang MK, Holihan JL, Itani K. et al. Ventral hernia management: expert consensus guided by systematic review. Ann Surg 2017; 265 (01) 80-89
    CrossrefPubMedSuche in Google Scholar
  • 20 Hassan AM, Lu S-C, Asaad M. et al. Novel machine learning approach for the prediction of hernia recurrence, surgical complication, and 30-day readmission after abdominal wall reconstruction. J Am Coll Surg 2022; 234 (05) 918-927
    CrossrefPubMedSuche in Google Scholar
  • 21 Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ. Posterior and open anterior components separations: a comparative analysis. Am J Surg 2012; 203 (03) 318-322 , discussion 322
    CrossrefPubMedSuche in Google Scholar
  • 22 Elhage SA, Marturano MN, Prasad T. et al. Impact of perforator sparing on anterior component separation outcomes in open abdominal wall reconstruction. Surg Endosc 2021; 35 (08) 4624-4631
    CrossrefPubMedSuche in Google Scholar
  • 23 Clarke JM. Incisional hernia repair by fascial component separation: results in 128 cases and evolution of technique. Am J Surg 2010; 200 (01) 2-8
    CrossrefPubMedSuche in Google Scholar
  • 24 Switzer NJ, Dykstra MA, Gill RS. et al. Endoscopic versus open component separation: systematic review and meta-analysis. Surg Endosc 2015; 29 (04) 787-795
    CrossrefPubMedSuche in Google Scholar
  • 25 Tong WMY, Hope W, Overby DW, Hultman CS. Comparison of outcome after mesh-only repair, laparoscopic component separation, and open component separation. Ann Plast Surg 2011; 66 (05) 551-556
    CrossrefPubMedSuche in Google Scholar
  • 26 Deerenberg EB, Timmermans L, Hogerzeil DP. et al. A systematic review of the surgical treatment of large incisional hernia. Hernia 2015; 19 (01) 89-101
    CrossrefPubMedSuche in Google Scholar
  • 27 Pauli EM, Rosen MJ. Open ventral hernia repair with component separation. Surg Clin North Am 2013; 93 (05) 1111-1133
    CrossrefPubMedSuche in Google Scholar
  • 28 Klima DA, Tsirline VB, Belyansky I. et al. Quality of life following component separation versus standard open ventral hernia repair for large hernias. Surg Innov 2014; 21 (02) 147-154
    CrossrefPubMedSuche in Google Scholar
  • 29 Blair LJ, Cox TC, Huntington CR. et al. The effect of component separation technique on quality of life (QOL) and surgical outcomes in complex open ventral hernia repair (OVHR). Surg Endosc 2017; 31 (09) 3539-3546
    CrossrefPubMedSuche in Google Scholar