P-024 Complex Abdominal Wall Reconstruction by Retromuscular Sublay Technique: Initial Experience in a Third-Level Hospital

Abstract

Aim Large or complex incisional hernias require more than just mesh placement.There are techniques such as component separation, retromuscular techniques (Rives-Stoppa, transversus abdominis muscle release-TAR), which help to repair the hernia and physiologically rebuild the abdominal wall.However, this type of technique can present a higher incidence rate of complications, such as hematomas, seromas, SSI, skin necrosis.We present our initial experience in complex abdominal wall reconstruction using the retromuscular sublay technique (RST). Methods Retrospective study analyzing our database of patients with complex incisional hernia undergoing abdominal wall surgery using the RST, during November-2018 to October-2020.In addition, we conducted a comparative analysis with patients undergoing hernia repair using the onlay-technique. Results 44 patients underwent RST (male:56.8%, age:66(IQR: 52–73years)). Hospital stay:4(IQR: 2–6days).Pathological history: diabetes mellitus (4.5%), arterial hypertension(20.5%), dyslipidemia(36.4%), smoking(34.1%), alcohol consumption(27.3%), cardiovascular disease(9.1%).ASA-classification:I(9.1%), II(59.1%), III(31.8%). BMI: 29.3±2kg/m2. Hernia location: midline(95.5%), others(4.5%). Preoperative botulinum toxin (PBT): 20.45%. Preoperative progressive pneumoperitoneum (PPP): 9.1%. Type of surgery performed: Rives-Stoppa(68.2%), TAR(31.8%). Postoperative complications: global(13.6%), Clavien-Dindo≥III:0%, clinical seroma(13.6%) and ultrasound-seroma(22.7%), SSI(0%). Hernia recurrence:0%. In the bivariate analysis of patients undergoing hernia repair using the RST compared to patients undergoing onlay repair, we observed that the RST presented lower incidence of global complications, both clinical and ultrasound seromas, surgical site infections and recurrences (13.6% vs 39.1% p=0.004; 13.6% vs 33.3% p=0.019; 22.7% vs 39.1% p=0.07; 0% vs 14.5% p=0.008; 0% vs 5.8% p=0.1; respectively). Conclusions In our enviroment, the management of complex incisional hernias using RST and the use of PBT and PPP is effective and safe, with a lower incidence of complications and recurrences.