“Components Separation Technique” for the Repair of Large Abdominal Wall Hernias

Reilingh, T. S. de Vries; Goor, Harry van; Rosman, Camiel; Bemelmans, M. H. A.; Jong, D. de; Nieuwenhoven, E.J. van; Engeland, M. I. A. van; Bleichrodt, Robert P.

doi:10.1016/s1072-7515(02)01478-3

Cited by 266 publications

(127 citation statements)

References 12 publications

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“…The aforementioned study demonstrated the lowest recurrence rate in a group undergoing CST hernia repair with soft polypropylene mesh. In the current study, the overall recurrence rate for primary component separation was 20.6%, consistent with other reports [6][7][8][9][10][11]. We were unable to demonstrate a significant difference in hernia recurrence rates between CST alone, CST with biologic mesh or CST with synthetic mesh with a mean follow up of 16 months.…”

Section: Discussionsupporting

confidence: 89%

“…While the CST was described without the additional utilization of bioprosthetic meshes, meshes are frequently used an adjunctive reinforcement to a ventral hernia repair. The use of a mesh as a reinforcement to a component separation hernia repair has been shown to both reduce [8,9] and increase recurrence rates [10,11]. This study evaluates the outcomes of CST over a five-year period of time at a single institution.…”

Section: Introductionmentioning

confidence: 99%

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Abdominal Wall Reconstruction Utilizing the Component Separation Technique: Does Reinforcing Mesh Reduce Recurrences?

Roth¹

2013

Surgery Curr Res

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Purpose: The component separation technique was initially described as an autologous tissue transfer without biomaterials. This study evaluates the results of component separation hernia with and without reinforcing mesh. Methods Results:The recurrence rate was 20.6% and wound complications occurred in 46%. Body mass index was associated with postoperative wound complications (non-obese 31.3%, overweight 31.8%, obesity/morbid obesity 51%, superobese 69%) but did not impact hernia recurrence rates (non-obese 7%; overweight 12.5%; obesity/morbid obesity 28.8%, super obese, 23.2%; p=0.207). Gender, diabetes, hypertension, pulmonary disease, and smoking status did not impact recurrence rate or wound complications. Prior hernia repairs did not impact recurrence rates (none, 17%; 1, 26.7%, 2+, 23.1%; p=0.589). 58 underwent repair without mesh, 55 with biologic mesh, and 13 with synthetic mesh. There were no differences in recurrences between groups. Conclusion:Obesity significantly increases wound complications following CST hernia repair. Recurrence rates following primary and recurrent hernia repairs are similar. The adjunct of reinforcing mesh does not affect recurrence rates following CST.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Abdominal Wall Reconstruction Utilizing the Component Separation Technique: Does Reinforcing Mesh Reduce Recurrences?

Roth¹

2013

Surgery Curr Res

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“…Over the years, several surgical procedures have been developed to manage these abdominal wall defects without using mesh, primarily using reconstructive plastic surgery with autologous flap repair or the component separation technique. Even in these cases, postoperative complications and hernia relapse are high, ranging respectively from 20% to 43% and 8% to 32%, respectively [9][10][11] . For these reasons, in cases of contaminated or potentially contaminated abdominal wall defect, abdominal wall defect in pre-irradiated tissues, giant ventral hernia with loss of domain or recurrent hernia on infected mesh, the use a mesh material able to resist infection after its implantation is strongly recommended.…”

Section: Discussionmentioning

confidence: 97%

Use of bovine pericardium graft for abdominal wall reconstruction in contaminated fields

D’Ambra¹,

Berti²,

Feleppa³

et al. 2012

WJGS

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AIM:To employ, in such conditions, a biological graft such as bovine pericardium that offers resistance to infection. METHODS:In our surgical department, from January 2006 to June 2010, 48 patients underwent abdominal wall reconstruction using acellular bovine pericardium; of these 34 patients had a contaminated wound due to diffuse peritonitis (complicated diverticulitis, bowel perforation, intestinal infarction, strangled hernia, etc. ) and 14 patients had hernia relapse on infected synthetic mesh. RESULTS:In our series, one patient died of multiorgan failure 3 d after surgery. After placement of the pericardium mesh four cases of hernia relapse occurred. CONCLUSION:Recurrence rate is similar to that of prosthetic mesh repair and the application of acellular bovine pericardium (Tutomesh ® , Tutogen Medical Gmbh Germany) is moreover a safe and feasible option that can be employed to manage complicated abdominal wall defects where prosthetic mesh is unsuitable.

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“…47 Many surgeons recommend the additional application of synthetic mesh in an onlay position to supplement the attenuated layers of the anterior abdominal wall. 48 In a relatively large series of 43 patients, de Vries Reilingh and colleagues 49 were unable to reproduce the good results of Ramirez and recorded recurrent hernia in 32% of patients at 15-month follow-up.…”

Section: Components' Separation Techniquementioning

confidence: 98%

The Management of Incisional Hernia

Kingsnorth

2006

annals

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Ann R Coll Surg Engl 2006; 88: 252-260 252Medline and Embase were searched using the search terms 'hernia' and 'incisional' alone and in combination. Publications were selected mostly in the past 5 years, but did not exclude commonly reference and highly regarded older publications. The reference list of articles was also searched, identified by the search strategy and those selected that were relevant. Selected review articles and metaanalyses were included because they provide comprehensive overviews that may be beyond the scope of this article. OverviewThe introduction of prosthetic mesh revolutionised the treatment of groin hernia but, to date, has had little impact on the treatment of incisional hernia.1 The risk factors for the development of incisional hernia include obesity, diabetes, emergency surgery, postoperative wound dehiscence, smoking and postoperative wound infection. 2,3The risks of repairing an incisional hernia which should be explained to the patient when obtaining consent include seroma formation, wound infection, injury to intraabdominal structures and recurrence. 4 Major complications which can occur in repair of large incisional hernias include mesh infection and enterocutaneous fistula which may result in prolonged morbidity and require re-operation (Fig. 1). It is now accepted that only the smallest (less than 3 cm) incisional hernias should be repaired with primary tissue approximation with sutures and this topic will not be discussed further.5 Small incisional hernias with time develop into larger incisional hernias due to the continuous presence of intra-abdominal hydrostatic pressure of 15 cm of water, diaphragmatic contractions occurring with respiration, increases in abdominal pressure occurring with coughing and straining realising pressures of over 80 cm of water and myofascial retraction of the lateral muscles. As a result, the abdominal cavity contracts and the right of domicile for the herniated visceral mass is lost. 6 Due to several previous operations, many of these patients have poor-quality abdominal wall musculature which, coupled with multiple co-morbid medical problems, present a surgical and anaesthetic challenge.Surgeons appear to have a reluctance to operate on incisional hernias perhaps because of the poor general condition of the patients but perhaps also due to lack of knowledge of how to deal with the various defects occurring as a result of incisions of the anterior abdominal wall and the operative techniques required. For instance, although it is estimated that 13% of laparotomy incisions fail in The Netherlands, only 4% of patients undergoing a laparotomy will go through additional surgery to repair an incisional hernia.7 Suture repair is likely to produce results twice as bad as mesh repair and the current techniques that surgeons are using to repair incisional hernias with prosthetic mesh continue to yield recurrence rates of greater than 20%. Many thousand laparotomy incisions are created each year and the failure rate for closure of these abdominal wou...

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“Components Separation Technique” for the Repair of Large Abdominal Wall Hernias

Cited by 266 publications

References 12 publications

Abdominal Wall Reconstruction Utilizing the Component Separation Technique: Does Reinforcing Mesh Reduce Recurrences?

Abdominal Wall Reconstruction Utilizing the Component Separation Technique: Does Reinforcing Mesh Reduce Recurrences?

Use of bovine pericardium graft for abdominal wall reconstruction in contaminated fields

The Management of Incisional Hernia

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