Component Separation or Mesh Repair for Ventral Hernia Repair - The Role of Mesh in Covering all the Abdominal Wall in the Component Repair

Abstract

Simple repair of the hernia opening, Ventral Hernia Repair (VHR) has been confronted by a more definitive goal of restoration of abdominal muscular strength and wall function accomplished by mobilizing abdominal wall muscles and closing with inlay mesh, Component Separation Repair (CSR). Our observation was based on the notion that shear forces cause herniation and therefore that is an affliction of the entire abdominal wall, not a localized event. We took that information and we compare a series of VHR patients with a series of CSR patients would provision evidence to improve the relative value of the techniques.Material: Retrospective comparison of 30 consecutive CSR patients and 30 consecutive VHR patients was obtained. All abdominal wall hernia defects were at least 10 cm 2 in size. T tests with unequal variances were used to evaluate differences in means of continuous variables and to estimate 95% confidence intervals of differences.Results: Although CSR patients were older, had higher BMI's and higher ASA scores than did VHR patients, the odds of recurrence for CSR patients were less than for VHR patients (P<0.0001). Differences in respects to ileus and wound complications, while they favored CSR patients, might have been due to chance (P>0.05 for each analysis). In VHR group 11 patients required CSR after 9-24 months, 14 patients have prolonged ileus. In the CSR group two patients were reoperated for removal of midline skin changes, two for severe seromas requiring wash up of the subcutaneous and fascia area and placement of a wound vacuum on top of the mesh. Conclusion:This study supports the notion that a ventral hernia reflects a defect in the abdominal wall not just the point at which the hernia forms. To avoid a point of rupture, we support highly the CSR technique, since hernia is an abdominal disease not just a hole.