The impact of component separation technique versus no component separation technique on complications and quality of life in the repair of large ventral hernias

Maloney, Sean R.; Schlosser, Kathryn A.; Prasad, Tanushree; Colavita, Paul D.; Kercher, Kent W.; Augenstein, Vedra A.; Heniford, B. Todd

doi:10.1007/s00464-019-06892-x

Cited by 25 publications

(24 citation statements)

References 33 publications

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“…We found that AWR-CS was utilized in 6.8% of these cases and was associated with increased overall complications that result in increased healthcare utilization in terms of LOS and costs. These complications were due to surgical wound-related complications for the most part, which is in line with prior data [18] .…”

Section: Discussionsupporting

confidence: 89%

“…In these patients, successful IHR can be difficult due to a history of open abdomen and reoperations that often cause distorted abdominal wall anatomy (i.e., limited tissue elasticity, migration of the rectus abdominis muscle and decreased compliance of the oblique musculature). Given the complexity of IH after a trauma laparotomy, AWR with component separation may be required in some cases to achieve a durable abdominal closure while improving health-related quality of life [18] . This technique is often used in complex situations [19] and requires a multidisciplinary approach that includes anesthesiologists, general surgeons and plastic surgeons [20] to allow additional fascial approximation that would not be possible otherwise.…”

Section: Discussionmentioning

confidence: 99%

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Abdominal wall reconstruction with component separation at the time of incisional hernia among survivors of emergency laparotomy after traumatic injuries: a population-based analysis of complications and healthcare utilization

Rios-Diaz¹,

Cunning²,

Mellia³

et al. 2021

PAR

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Aim: The utilization and outcomes of abdominal wall reconstruction (AWR) using advanced techniques such as component separation for incisional hernia (IH) repair following laparotomy in trauma populations has not been described. The objective was to describe AWR with component separation (AWR-CS) utilization in this setting and to assess postoperative complications and readmissions. Methods: We identified adult patients admitted for IH repair (IHR) with a history of and admission for traumatic injuries with concurrent laparotomy in six geographically diverse statewide inpatient databases (2006-2015). AWR-CS was defined by ICD-9 codes corresponding to myocutaneous flap. Risk-adjusted logistic regression and generalized linear models were used to compare postoperative complications, 30-day readmissions and cumulative costs associated with AWR-CS.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Abdominal wall reconstruction with component separation at the time of incisional hernia among survivors of emergency laparotomy after traumatic injuries: a population-based analysis of complications and healthcare utilization

Rios-Diaz¹,

Cunning²,

Mellia³

et al. 2021

PAR

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“…To add more to the problem, evidence exists that increasing BMI is correlated with decreased density of major deep inferior epigastric perforators (35). More interestingly, repair of large incisional hernias with achievement of primary fascial closure without components separation appears to yield similar hernia recurrence rates but significantly lower wound infection rates compared to primary fascial closure with use of components separation (36). In this cohort of patients, similarly low rates of bridging 1.8% in the no-component separation group and 2.7% in the components separation group were reported, suggesting that it is the achievement of midline recreation in a tension-free manner that is the key driver for hernia recurrence prevention.…”

Section: Resultsmentioning

confidence: 99%

Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes

Seretis

Chrysikos

Samolis

et al. 2021

In Vivo

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Background/Aim: Abdominal wall hernias represent a common problem in surgical practice. A significant proportion of them entails large defects, often difficult to primarily close without advanced techniques. Injection of botulinum toxin preoperatively at specific points targeting lateral abdominal wall musculature has been recently introduced as an adjunct in achieving primary fascia closure rates. Materials and Methods: A literature search was conducted investigating the role of botulinum toxin in abdominal wall reconstruction focusing on anatomic repair of hernia defects. Results: Injecting botulinum toxin preoperatively achieved chemical short-term paralysis of the lateral abdominal wall muscles, enabling a tension-free closure of the midline, which according to anatomic and clinical studies should be the goal of hernia repair. No significant complications from botulinum injections for complex hernias were reported. Conclusion: Botulinum is a significant adjunct to complex abdominal wall reconstruction. Further studies are needed to standardize protocols and create more evidence.Abdominal wall hernias represent a common problem in current surgical practice. Over 20% of all abdominal operations performed in the US annually are complicated by development of an incisional hernia (1). In an attempt to identify the key players in the successful treatment of the most challenging subgroup of these hernias, namely the complex hernias, a scheme identifying size and location, contamination and soft tissue infection as well as patient history and risk factors has been proposed (2). Incisional hernias are well known to recur after repair (3), thus underlying the importance of solid knowledge of relevant anatomy, technique and most importantly new adjuncts in treatment. More advanced techniques in hernia repair were developed such as Rives-Stoppa retro-rectus repair and, subsequently, posterior components separation whith the goal to achieve primary and tension-free myo-fascial closure reinforced by mesh placement (4). The goal of this study was to review current evidence regarding the use of botulinum toxin in the treatment of abdominal wall hernia repair, in a critical manner.

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“…These patients can be found in a wide range from those who underwent a simple umbilical hernia to wide ventral hernias with multiple incisional operations. In addition, there may be quite different surgical techniques such as how the mesh is placed (onlay, inlay, sublay), mesh type and whether or not compartment separation is performed 15,18 . Also, the pannus tissue volume of the panniculectomy shows significant differences.…”

Section: Discussionmentioning

confidence: 99%

Tek seansta ventral herni onarımı ile birlikte pannikülektomi de uygulanmalı mı?

Kırmızı¹,

Hüseyinoğlu²

2021

Cukurova Medical Journal

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The aim of this study is to investigate whether simultaneous panniculectomy applications in ventral hernia repair increases postoperative morbidity rates. Materials and Methods: The study was carried out retrospectively between January 2018 and December 2020. The patients were evaluated in terms of sex, age, body mass index, accompanying diseases, hernia type and size, abdominal surgery history, ASA value (American Society of Anesthesiology), postoperative complications, hospitalization, and follow-up durations. Post-operative complications were evaluated according to the Clavien-Dindo classification. Results: It was determined that 14 patients underwent simultaneous panniculectomy and ventral hernia repair (Group 1), while 27 patients underwent sole ventral hernia repair (Group 2). In Group 1, the hernia defect area was approximately 6.25-fold higher. In patients with a panniculectomy, hospitalization time was significantly longer. The median follow-up period was 8.5 months (2-14) in Group 1, and 14 months in Group 2 (3-36). In multiple linear regression analyses, only the effect hernia defect area was significant on the hospitalization time. There were no significant differences between the groups in terms of complications and hernia recurrence. Conclusion: Simultaneous panniculectomy applications in ventral hernia repairs do not increase the rate of complications and hernia recurence. A simultaneous panniculectomy application can be applied safely to patients who want to "eliminate" both of their problems in a single session. Amaç: Bu çalışmanın amacı, ventral hernide eş zamanlı pannikülektomi uygulamasının postoperatif morbidite oranlarını artırıp artırmadığını araştırmaktır. Gereç ve Yöntem: Çalışma Ocak 2018-Aralık 2020 tarihleri arasında Yozgat Şehir Hastanesi Genel Cerrahi Servisinde, retrospektif olarak gerçekleştirildi. Hastaların cinsiyet, yaş, vücut kitle indeksi, yandaş hastalıkları, herni tipi ve boyutu, geçirilmiş karın cerrahisi öyküsü, ASA değeri (American Society of Anesthesiology), post-operatif komplikasyonlar, hastane yatış ve takip süreleri değerlendirildi. Post-operatif komplikasyonlar Clavien-Dindo sınıflamasına göre değerlendirildi. Bulgular: On dört hastaya eş zamanlı pannikülektomi ve ventral herni onarımı (Grup 1), 27 hastaya sadece ventral herni onarımı (Grup 2) yapıldı. Grup 1'de herni defekti alanı yaklaşık 6,25 kat daha fazlaydı. Hastane yatış süresi pannikülektomi uygulanan hastalarda anlamlı olarak daha uzundu. Ortanca takip süresi Grup 1 hastalarda 8,5 ay (2-14), diğer grupta 14 aydı . Çoklu lineer regresyon analizlerinde hastane yatış süresi üzerinde sadece herni defekt alanın anlamlı etkisi olduğu görüldü. En ciddi komplikasyon Clavien-Dindo sınıflamasına göre 3b (genel anestezi altında cerrahi müdahale) grubunda oluşan cilt nekrozuydu. Yara yeri komplikasyon ve herni rekürrensi açısından gruplar arasında anlamlı fark saptanmadı. Sonuç: Ventral herni onarımların eş zamanlı pannikülektomi uygulaması komplikasyonları ve nüks oranını artırmamaktadır. Her iki probleminden de tek s...

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The impact of component separation technique versus no component separation technique on complications and quality of life in the repair of large ventral hernias

Cited by 25 publications

References 33 publications

Abdominal wall reconstruction with component separation at the time of incisional hernia among survivors of emergency laparotomy after traumatic injuries: a population-based analysis of complications and healthcare utilization

Abdominal wall reconstruction with component separation at the time of incisional hernia among survivors of emergency laparotomy after traumatic injuries: a population-based analysis of complications and healthcare utilization

Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes

Tek seansta ventral herni onarımı ile birlikte pannikülektomi de uygulanmalı mı?

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