What Do We Know About Component Separation Techniques for Abdominal Wall Hernia Repair?

Scheuerlein, H.; Thiessen, A.; Schug-Paß, C.; Köckerling, F.

doi:10.3389/fsurg.2018.00024

Cited by 52 publications

(40 citation statements)

References 38 publications

(77 reference statements)

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“…Perforating vessels are also out of harm's way with open, laparoscopic, and laparoscopically assisted robotic transversus abdominis release procedures. [4][5][6] It is not the intent of this report to describe operative techniques. Even so, it should be mentioned that all of these techniques have been modified to the extent that there is no standard approach.…”

Section: Discussionmentioning

confidence: 99%

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Comparing Surgical Site Infection for Open and Endoscopic Component Separation

Palmer

Mcdaniel

Samra

et al. 2019

The American Surgeon

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In March 2016, we reported the SSI rate at LSU Health for all abdominal wall hernia repairs performed between 2011 and 2013. Among the 263 repairs, the infection rate averaged 6.8 per cent. Given the diversity of repairs, this global percentage lacks relevance, but looking at subsets provides meaningful insights. For example, SSI was 1.8 per cent among 55/263 laparoscopic repairs and 8.2 per cent among 206/263 open repairs. The infection rate of 26.3 per cent among the 19 open component separation cases was especially noteworthy and bothersome. Even though there was no mortality in any subset, the vast majority of the morbidity and costs involved repairs with open component separations. A meta-analysis published in 2016 revealed a likely SSI benefit for the endoscopic component separation technique (ECST) over the open CST. Since that report, we have focused our quality improvement efforts on this subset of challenging cases and have replaced CST with ECST. Our data now include results from 33 hernia repairs with either CSTor ECST that were performed between November 2011 and April 2018. Twenty-four of 33 patients had CSTwith an SSI rate of 37.5 per cent (9 of 24). Nine of 33 had ECST with 0 per cent SSI (P value = 0.039). These results mirror the findings reported in the meta-analysis.

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Section: Discussionmentioning

confidence: 99%

“…ECST avoids this problem. 3,4 In addition to ECST, there are other equally satisfactory options. Perforating vessels are also out of harm's way with open, laparoscopic, and laparoscopically assisted robotic transversus abdominis release procedures.…”

Section: Discussionmentioning

confidence: 99%

Comparing Surgical Site Infection for Open and Endoscopic Component Separation

Palmer

Mcdaniel

Samra

et al. 2019

The American Surgeon

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“…Although he prefers posterior component separation with transverses abdominis release rather than ACS. Hubert Scheuerlein et al 12 in his study on CST says that it was developed to reconstruct complex hernias although he also prefers posterior CST. According to his work CST alone without mesh must not be used because of high recurrence rate.…”

Section: Discussionmentioning

confidence: 99%

Anterior component separation with sublay polypropylene mesh placement: An ideal way to deal with large ventral abdominal hernias.

Rashid

2021

TPMJ

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Objectives: To study the effectiveness of open anterior component separation technique for repair of large incisional abdominal hernias. To study the effect of addition of polypropylene mesh with open anterior CST in sublay position. Study Design: Experimental study. Setting: Department of Surgery, DHQ Hospital Rawalpindi. Period: January 2016 to November 2016. Material & Methods: Patients (n=19) were admitted through OPD electively by purposive non- probability sampling in accordance with the inclusion/exclusion criteria. patients were operated under general anaesthesia. Anterior CST was done by standard Ramirez technique. Polypropylene mesh was placed in sublay (retrorectus) position. Data obtained was analysed by SPSS-20 software to calculate SSI and Recurrence rate. Results: A total of 19 (n=19) patients were included in the study and operated upon.There were 61% males with average age of 42 years and 39% females of average31 years.Average defect size was 10.11 cm with SD of 1.899 cm. Recurrence rate was 5.26%. SSI rate was 10.50%. Patients were followed up for one year for Recurrence of hernia. Conclusion: Anterior component separation is an effective technique for repair of otherwise inoperable large ventral abdominal hernias especially when combined with polypropylene mesh in sublay position. Addition of mesh in sublay position with CST signifantly reduces both recurrence and SSI rate.

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“…synthetic, bioresorbable, biological [ 29 ]) Anatomical plane for mesh insertion [ 30 ] Whether a previous mesh needs explanting Whether concomitant GI surgery (e.g. GI fistula, reversal of stoma, restoration of GI continuity or bariatric surgery) is required Whether component separation is required [ 31 , 32 ] …”

Section: Our York Pathwaymentioning

confidence: 99%

A structured pathway for developing your complex abdominal hernia service: our York pathway

Smith

MacLeod

Lim

et al. 2021

Hernia

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Purpose Clinical pathways are widely prevalent in health care and may be associated with increased clinical efficacy, improved patient care, streamlining of services, while providing clarity on patient management. Such pathways are well established in several branches of healthcare services but, to the authors’ knowledge, not in complex abdominal wall reconstruction (CAWR). A stepwise, structured and comprehensive approach to managing complex abdominal wall hernia (CAWH) patients, which has been successfully implemented in our practice, is presented. Methods A literature search of common databases including Embase® and MEDLINE® for CAWH pathways identified no comprehensive pathway. We therefore undertook a reiterative process to develop the York Abdominal Wall Unit (YAWU) through examination of current evidence and logic to produce a pragmatic redesign of our own pathway. Having introduced our pathway, we then performed a retrospective analysis of the complexity and number of abdominal wall cases performed in our trust over time. Results We describe our pathway and demonstrate that the percentage of cases and their complexity, as defined by the VHWG classification, have increased over time in York Abdominal Wall Unit. Conclusion A structured pathway for complex abdominal wall hernia service is one way to improve patient experience and streamline services. The relevance of pathways for the hernia surgeon is discussed alongside this pathway. This may provide a useful guide to those wishing to establish similar personalised pathways within their own units and allow them to expand their service.

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What Do We Know About Component Separation Techniques for Abdominal Wall Hernia Repair?

Cited by 52 publications

References 38 publications

Comparing Surgical Site Infection for Open and Endoscopic Component Separation

Comparing Surgical Site Infection for Open and Endoscopic Component Separation

Anterior component separation with sublay polypropylene mesh placement: An ideal way to deal with large ventral abdominal hernias.

A structured pathway for developing your complex abdominal hernia service: our York pathway

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