Abdominal wall reconstruction with components separation and mesh reinforcement in complex hernia repair

Abstract

BackgroundAbdominal closure in the presence of enterocutaneous fistula, stoma or infection can be challenging. A single-surgeon’s experience of performing components separation abdominal reconstruction and reinforcement with mesh in the difficult abdomen is presented.MethodsMedical records from patients undergoing components separation and reinforcement with hernia mesh at Royal Liverpool Hospital from 2009 to 2012 were reviewed. Patients were classified by the Ventral Hernia Working Group (VHWG) grading system. Co-morbidities, previous surgeries, specific type of reconstruction technique, discharge date, complications and hernia recurrence were recorded.ResultsTwenty-three patients’ (15 males, 8 females) notes were reviewed. Median age was 57 years (range 20-76 years). Median follow-up at the time of review was 17 months (range 2-48 months). There were 13 grade III hernias and 10 grade IV hernias identified. Synthetic mesh was placed to reinforce the abdomen in 6 patients, cross-linked porcine dermis was used in 3, and a Biodesign® Hernia Graft was placed in 14. Complications included wound infection (13%), superficial wound dehiscence (22%), seroma formation (22%) and stoma complications (9%). To date, hernias have recurred in 3 patients (13%).ConclusionsComponents separation and reinforcement with biological mesh is a successful technique in the grade III and IV abdomen with acceptable rate of recurrence and complications.

Complex Incisional Hernias

“…The mesh reinforcement is controversially discussed for reasons of costs. The recurrence rate is (in the available non-controlled studies) reported comparably high (10-35%) and it is higher without mesh reinforcement [57][58][59][60][61][62][63][64][65]. The method can be performed in principal laparoscopically, too [66][67][68] and with advantages in obese patients [69].…”

Complex abdominal wall reconstruction in the setting of active infection and contamination: a systematic review of hernia and fistula recurrence rates

“…A total of 601 patients were included, with an average follow‐up of 26.7 months. Follow‐up was performed by clinical assessment in five studies , a combination of clinical assessment and telephone interviews in three studies and was not defined in seven studies . None of the studies gave a clear definition of hernia recurrence and only one differentiated between hernia and bulge .…”

Tratamiento de hernia ventral compleja contaminada en dos etapas

“…Su empleo permite la medialización de los bordes del defecto con cierre directo de la fascia (sin dejar un puente protésico), lo que disminuye el riesgo de recidiva. Dada la fragilidad lateral de la pared en este tipo de correcciones favorecida por la presencia de varios orificios de trocares laterales, se utiliza el remanente de la prótesis biosintética para el refuerzo de esta región más débil 15 . En la corrección de las HVCC el riesgo de infecciones de la herida quirúrgica es más elevado, por la presencia de factores de riesgo como la prótesis (cuerpo extraño), la disección amplia en las técnicas de separación de componentes, el tipo IV de hernia incisional categoría tipo IV de la clasificación VHWG, paciente ASA 3 y padecimiento de obesidad mórbida (IMC de 40 kg/m 2 ) 16 .…”