Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

Abstract

Aim To analyze the outcomes of component separation techniques (CST) to treat incisional hernias (IH) in a large multicenter cohort of patients. Methods All IH repair using CST, registered in EVEREG from July 2012 to December 2019, were included. Data on the pre-operative patient characteristics and comorbidities, IH characteristics, surgical technique, complications, and recurrence were collected. Outcomes between anterior (ACS) and posterior component separation (PCS) techniques were compared. Risk factors for complications and recurrences were analyzed. Results During the study period, 1536 patients underwent CST (45.5% females) with a median age of 64.0 years and median body mass index (BMI) of 29.7 kg/m2. ACS was the most common technique (77.7%). Overall complications were frequent in both ACS and PCS techniques (36.5%), with a higher frequency of wound infection (10.6% vs. 7.0%; P = 0.05) and skin necrosis (4.4% vs. 0.1%; P < 0.0001) with the ACS technique. Main factors leading to major complications were mesh explant (OR 1.72; P = 0.001), previous repair (OR 0.75; P = 0.038), morbid obesity (OR 0.67; P = 0.015), ASA grade (OR 0.62; P < 0.0001), COPD (OR 0.52; P < 0.0001), and longitudinal diameter larger than 10 cm (OR 0.58; P = 0.001). After a minimum follow-up of 6 months (median 15 months; N = 590), 59 (10.0%) recurrences were diagnosed. Operations performed in a non-specialized unit were significantly associated with recurrences (HR 4.903, CI 1.64–14.65; P = 0.004). Conclusion CST is a complex procedure with a high rate of complications. Both ACS and PCS techniques have similar complication and recurrence rates. Operations performed in a specialized unit have better outcomes.

Assessing Textbook Outcome After Implementation of Transversus Abdominis Release in a Regional Hospital

“…Larger cohort studies or data from national registries, varying from 184 to 3109 TAR cases, demonstrated slightly better outcomes than the smaller series: SSO 18–31%, SSE 19%, SSOPI 5-9% and recurrence 3-4% ( 6 , 10 , 18 , 19 , 50 , 51 ), which may be due to some learning curve effect.…”

“…Major surgeries in an aging population maintain the surgical epidemic of incisional hernias (1,2). Repairing these hernias remains fraught with complications, especially if a patient need a component separation technique (CST) for primary fascial closure (3)(4)(5)(6). Such complex abdominal wall repair procedures can be challenging, require well-organized peri-operative multidisciplinary guidance and a team which should be able to adopt new techniques (7).…”

STRONGHOLD first-year results of biomechanically calculated abdominal wall repair: a propensity score matching

“…We do not routinely look for such a significant fascial dehiscence 1 month after surgery [ 33 ]. However, complex reconstructions can have recurrence rates as high as 10% after 6 months [ 34 ]. After 43 months, 94% of all fascial distances greater than 12 mm had developed a manifest hernia [ 22 ].…”