Increased incidence of surgical site infection with a body mass index ≥ 35 kg/m2 following abdominal wall reconstruction with open component separation

The aim of our study was to determine whether patients with neutropenia (absolute neutrophil count (ANC) ≤1,500 cells/µL) had higher rates of surgical site infection after elective abdominal wall reconstruction. This was a case series from a prospective complex abdominal wall reconstruction cohort describing the surgical outcomes of 4 neutropenic patients (ANC ≤1,500 cells/µL) within 48 hours of index operation. Median age was 55 years, 3 patients were female. All patients had liver cirrhosis as a comorbidity: 2 patients as a result of alcohol abuse and 2 patients secondary to cryptogenic and nonalcoholic fatty liver disease, respectively. All patients underwent a posterior component separation with transversus abdominis release and retro-rectus biologic mesh. None of the 4 patients developed a surgical site infection 90 days postoperatively. Complex abdominal wall reconstruction in neutropenic patients could be safe.

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Comparing Surgical Site Infection for Open and Endoscopic Component Separation

The American Surgeon ◽

10.1177/000313481908500423 ◽

2019 ◽

Vol 85 (4) ◽

pp. 350-352

Author(s):

Derek S. Palmer ◽

Conner C. Mcdaniel ◽

Navdeep S. Samra ◽

F. Dean Griffen

Keyword(s):

Quality Improvement ◽

Surgical Site Infection ◽

Abdominal Wall ◽

Infection Rate ◽

Meta Analysis ◽

Abdominal Wall Hernia ◽

Component Separation ◽

Separation Technique ◽

P Value ◽

Site Infection

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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The Impact of Mesh Reinforcement with Components Separation for Abdominal Wall Reconstruction

The American Surgeon ◽

10.1177/000313481808400648 ◽

2018 ◽

Vol 84 (6) ◽

pp. 959-962 ◽

Cited By ~ 3

Author(s):

Seyed Amirhossein Razavi ◽

Karan A. Desai ◽

Alexandra M. Hart ◽

Peter W. Thompson ◽

Albert Losken

Keyword(s):

Postoperative Complications ◽

Surgical Site Infection ◽

Abdominal Wall ◽

Recurrence Rate ◽

Abdominal Wall Reconstruction ◽

Abdominal Hernia ◽

Fascial Closure ◽

Site Infection ◽

Components Separation ◽

The Impact

The goal in abdominal wall reconstruction (AWR) is to minimize morbidity and prevent hernia recurrence. Components separation and mesh reconstruction are two options, however, with advantages and disadvantages. The purpose of this review was to investigate outcomes in patients with abdominal wall hernia undergoing primary closure with component separation (CS) versus CS with acellular dermal matrix (ADM) reinforcement (CS + mesh). Medical records of consecutive patients who underwent abdominal wall reconstruction using CS with or without ADM reinforcement were retrospectively reviewed. Primary fascial closure was achieved in all patients. ADM reinforcement when used was performed using the underlay technique. Reconstructive technique and postoperative complications including delayed healing, skin necrosis, fistula, seroma, hematoma and surgical site infection, recurrence, and reoperation were recorded. Comparisons between the two groups were assessed. One hundred and seven patients were included (mean age, 55.7; 51.4% male; median follow-up 297 days). Twenty-six patients (24%) underwent CS alone; whereas 81 patients (76%) CS + mesh placement. Patient comorbidities, including smoking (26%), diabetes (20%), and hypertension (46%); body mass index (mean 32.3 ± 7.6); and albumin level on the day of surgery (mean 3.4 ± 0.5 mg/dL) were not significantly different between groups. Surgical site infection was significantly higher among CS + mesh patients (22.2%) versus CS only patients (3.9%) (P = 0.02). The recurrence rate of abdominal hernia was significantly lower in CS + mesh patients compared with CS only (14.8% vs 34.6%; P = 0.02). No significant differences in other postoperative complications were identified between the two groups. ADM reinforcement at the time of components separation is often selected in more complex, higher risk patients. Although the incidence of infection was higher in these patients, it was usually treated without mesh removal and recurrence rate was significantly lower when compared to CS alone.

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