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

Context: Advances in Abdominal Wall Reconstruction including abdominal component separation techniques have enabled repair of complex ventral hernias whereas patients may have been denied surgery earlier. Traditionally the reason to operate ventral hernias has been the risk of strangulation. Something that is under studied is the effect of complex ventral hernias on Quality of Life (QoL) and how does it change after surgery.Whether techniques that require division of abdominal wall components impair abdominal wall function and consequently affect QoL is not determined. Aim:To assess the change in QOL at three months after surgery and compare it to the QOL immediately before surgery. Apart from the primary outcome of change in QOL, short term complications were also studied.A subgroup analysis of change in QOL after component separation technique was also done Settings and Design:A prospective analysis was carried out on consecutive patients undergoing open complex ventral hernia surgery over two-year period at our institution,a tertiary care hospital. Methods and Material:Patients with complex ventral hernias including those with hernia defect diameter more than 6 cm, recurrent hernia, multiple Swiss cheese defects, or patients requiring abdominal component separation were studied. Patients requiring emergency surgery and laparoscopic surgeries were excluded from study. The “HerniaRelated Quality-of-Life Survey”(HerQLes) which is a validated instrument was used. Statistical analysis used: After sample size estimation by a statistician forty-five consecutive patients meeting the study criteria between April 2017 and March 2019 were included in the study.Statistical analyses were done using SPSS version 24 software. Results:Of the 45 patients enrolled in the study,19 (42.2%) required abdominal component separation.The mean size of 2 the defect was 130 cm in component separation (CS) group and 39.0 cm2 in non-component separation (NCS) group. The mean preoperative QoL score in CS group was 53.9±11.2, while in the NCS group it was 45.7±13.6. QoL score postoperatively in CS group was 16.4±4, while in NCS group it was 13.8±1.5. There was a statistically significant improvement in QoL three months after surgery in both the groups (p-0.0001). Conclusion: In our study we found complex ventral hernias to be associated with a poor Quality of Life.The Quality of Life was seen to improve significantly within three months after surgery.Use of a component separation technique does not seem to impair the Quality of life.

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Quality of Life after Ventral Hernia Repair with Endoscopic Component Separation Technique

Scandinavian Journal of Surgery ◽

10.1177/1457496915571402 ◽

2015 ◽

Vol 105 (1) ◽

pp. 11-16 ◽

Cited By ~ 6

Author(s):

C. Ø. Thomsen ◽

T. L. Brøndum ◽

L. N. Jørgensen

Keyword(s):

Quality Of Life ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Component Separation ◽

Separation Technique ◽

Component Separation Technique

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The effect of component separation technique on quality of life (QOL) and surgical outcomes in complex open ventral hernia repair (OVHR)

Surgical Endoscopy ◽

10.1007/s00464-016-5382-z ◽

2016 ◽

Vol 31 (9) ◽

pp. 3539-3546 ◽

Cited By ~ 14

Author(s):

Laurel J. Blair ◽

Tiffany C. Cox ◽

Ciara R. Huntington ◽

Steven A. Groene ◽

Tanushree Prasad ◽

...

Keyword(s):

Quality Of Life ◽

Hernia Repair ◽

Ventral Hernia ◽

Surgical Outcomes ◽

Ventral Hernia Repair ◽

Component Separation ◽

Separation Technique ◽

Open Ventral Hernia Repair ◽

Component Separation Technique

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Use of Acellular Dermal Matrix Combined with a Component Separation Technique for Repair of Contaminated Large Ventral Hernias: A Possible Ideal Solution for this Clinical Challenge

The American Surgeon ◽

10.1177/000313481508100226 ◽

2015 ◽

Vol 81 (2) ◽

pp. 150-156 ◽

Cited By ~ 1

Author(s):

Fei Yang ◽

Li Ji-Ye ◽

Li Rong ◽

Tian Wen

Keyword(s):

Acellular Dermal Matrix ◽

Component Separation ◽

Separation Technique ◽

Oblique Muscle ◽

Dermal Matrix ◽

Surgical Infection ◽

Wound Debridement ◽

Component Separation Technique ◽

Acellular Dermal ◽

Ventral Hernias

Repair of large contaminated ventral hernias is always challenging because of massive loss of muscular and fascial tissues, high risk of surgical infection and recurrence, and contraindication to use of a permanent prosthesis. This study reviewed retrospectively data of 35 patients with contaminated large ventral hernias who received repair using acellular dermal matrix combined with a component separation technique from 2009 to 2011. Twenty-one males and 14 females were identified with a mean age of 45.5 ± 12.5 years and a mean body mass index of 22.5 ± 5.8 kg/m2. Simultaneously, nine patients underwent bowel fistula resection, 13 patients underwent ostomy takedown, five patients underwent recurrent colon cancer dissection, and eight patients underwent infectious permanent mesh removal and wound débridement. Mean defect size was 125.0 ± 23.5 cm2. The aponeurosis of the external oblique muscle was transected and separated from internal oblique muscle to reach abdominal closure. A cellular dermal matrix was placed in an onlay fashion and mean mesh size was 300.0 ± 65.0 cm2. Thirty-five patients had a mean follow-up period of 36.5 ± 12.5 months. Wound bleeding and partial dehiscence occurred at 36 hours post-operatively. Five patients reported abdominal wall pain during the first postoperative month. Five patients developed surgical site infection. Four patients were detected to develop seroma with volume more than 20 mL by B-ultrasound examination. No recurrence and chronic foreign body sensation were followed up. Use of acellular dermal matrix combined with a component separation technique is safe and efficient management for repair of contaminated large ventral hernia, in which permanent prosthesis placement is contraindicated.

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The principles of complex abdominal hernia repair

10.1093/med/9780199682874.003.0103 ◽

2021 ◽

pp. 1185-1194

Author(s):

Kezia Echlin ◽

Andrew Fleming

Keyword(s):

Significant Risk ◽

Rectus Abdominis ◽

Component Separation ◽

Separation Technique ◽

Abdominal Hernia ◽

Wound Complications ◽

Component Separation Technique ◽

Epigastric Artery ◽

Deep Inferior Epigastric Artery ◽

Ventral Hernias

Large, complex abdominal hernias can be repaired with the component separation technique, which creates sliding bipedicled flaps of the rectus abdominis to allow autogenous repair of midline, ventral hernias. This technique involves longitudinal release of the external oblique aponeurosis just lateral to the linea semilunaris, and developing the plane between the external and internal oblique muscles to allow the rectus abdominis muscle and sheath to slide medially. Modifications of the original technique include the addition of mesh reinforcement, release of the deeper elements of the abdominal wall, and sparing of the peri-umbilical perforators to the skin from the deep inferior epigastric artery. Component separation technique is an effective technique to repair large ventral hernias but carries a significant risk of wound complications and a risk of cardiorespiratory compromise.

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Self-Compassion and Quality of Life in Adults Who Stutter

American Journal of Speech-Language Pathology ◽

10.1044/2020_ajslp-20-00055 ◽

2020 ◽

Vol 29 (4) ◽

pp. 2097-2108

Author(s):

Robyn L. Croft ◽

Courtney T. Byrd

Keyword(s):

Quality Of Life ◽

Social Connectedness ◽

The Self ◽

Future Research ◽

Self Compassion ◽

Adults Who Stutter ◽

And Gender ◽

Relationship Of ◽

The Impact

Purpose The purpose of this study was to identify levels of self-compassion in adults who do and do not stutter and to determine whether self-compassion predicts the impact of stuttering on quality of life in adults who stutter. Method Participants included 140 adults who do and do not stutter matched for age and gender. All participants completed the Self-Compassion Scale. Adults who stutter also completed the Overall Assessment of the Speaker's Experience of Stuttering. Data were analyzed for self-compassion differences between and within adults who do and do not stutter and to predict self-compassion on quality of life in adults who stutter. Results Adults who do and do not stutter exhibited no significant differences in total self-compassion, regardless of participant gender. A simple linear regression of the total self-compassion score and total Overall Assessment of the Speaker's Experience of Stuttering score showed a significant, negative linear relationship of self-compassion predicting the impact of stuttering on quality of life. Conclusions Data suggest that higher levels of self-kindness, mindfulness, and social connectedness (i.e., self-compassion) are related to reduced negative reactions to stuttering, an increased participation in daily communication situations, and an improved overall quality of life. Future research should replicate current findings and identify moderators of the self-compassion–quality of life relationship.

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