scholarly journals Combining anterior and posterior component separation for extreme cases of abdominal wall reconstruction

Hernia ◽  
2020 ◽  
Vol 24 (2) ◽  
pp. 369-379 ◽  
Author(s):  
J. Lopez-Monclus ◽  
J. Muñoz-Rodríguez ◽  
C. San Miguel ◽  
A. Robin ◽  
L. A. Blazquez ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Component Separation ◽  
Posterior Component Separation ◽  
Posterior Axillary Line ◽  
The Mean ◽  
Anterior Component Separation ◽  
Midline Closure

Abstract Purpose The closure of midline in abdominal wall incisional hernias is an essential principle. In some exceptional circumstances, despite adequate component separation techniques, this midline closure cannot be achieved. This study aims to review the results of using both anterior and component separation in these exceptional cases. Methods We reviewed our experience using the combination of both anterior and posterior component separation in the attempt to close the midline. Our first step was to perform a TAR and a complete extensive dissection of the retromuscular preperitoneal plane developed laterally as far as the posterior axillary line. When the closure of midline was not possible, an external oblique release was made. A retromuscular preperitoneal reinforcement was made with the combination of an absorbable mesh and a 50 × 50 polypropylene mesh. Results Twelve patients underwent anterior and posterior component separation. The mean hernia width was 23.5 ± 5. The majority were classified as severe complex incisional hernia and had previous attempts of repair. After a mean follow-up of 27 months (range 8–45), no case of recurrence was registered. Only one patient (8.33%) presented with an asymptomatic bulging in the follow-up. European Hernia Society’s quality of life scores showed a significant improvement at 2 years postoperatively in the three domains: pain (p = 0.01), restrictions (p = 0.04) and cosmetic (p = 0.01). Conclusions The combination of posterior and anterior component separation can effectively treat massive and challenging cases of abdominal wall reconstruction in which the primary midline closure is impossible to achieve despite appropriate optimization of surgery.

Abdominal Wall Expanding System. Intraoperative Abdominal Wall Expansion as a Technique to Repair Giant Incisional Hernia and Laparostoma. New and Long-Term Results From a Three-Center Feasibility Study

2021 ◽  
pp. 155335062110414
Author(s):  
Dietmar Eucker ◽  
Nadine Rüedi ◽  
Clinton Luedtke ◽  
Oliver Stern ◽  
Henning Niebuhr ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Long Term Results ◽  
Anatomical Reconstruction ◽  
Time Saving ◽  
Lateral Abdominal Wall ◽  
Hernia Size ◽  
Midline Closure

Background The abdominal wall expanding system (AWEX) was first applied in 2012 and published in 2017. This novel technique was developed to reconstruct complex incisional hernias and residual skin-grafted laparostoma after treatment of an open abdomen, when primary midline closure was impossible. The main aim was the anatomical reconstruction of the abdominal wall and the avoidance of dissecting techniques (component separation). Methods Between 2012 and 2019, 33 patients underwent AWEX hernia repair in three certified hernia centers. The retracted abdominal wall was stretched with the AWEX system intraoperatively for approximately 30 min. Hernia size was measured preoperatively, on CT, and intraoperatively. The gain in length on the lateral abdominal wall (decrease in width of the defect) after stretching and any residual midline gap were determined in the OR. Results 33 patients underwent AWEX procedures. Six cases were evaluated separately because of additional procedures (TAR, four cases) and preoperative application of botulinum toxin (two cases). The median (95% confidence interval) measured width of hernia defects was 13 (12–16) cm, the median gain in length on the lateral abdominal wall was 12 (10–15) cm. After median follow-up of 29 (12–54) months, one recurrence from the broken mesh was observed. No method-related complications occurred. Conclusion Based on the 2017 and current results, the AWEX system represents an alternative or supplemental procedure to current techniques for complex abdominal wall reconstruction. The system proved again to be time-saving, safe, effective, and easy to learn. Further studies with enhanced technology are in progress.

scholarly journals O50 ALTERATIONS IN THE ABDOMINAL WALL MUSCULATURE AFTER ENDOSCOPIC ANTERIOR AND OPEN POSTERIOR COMPONENT SEPARATION

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Erling Oma ◽  
Jan Kim Christensen ◽  
Jorge Daes ◽  
Lars Nannestad Jorgensen
Keyword(s):  
Abdominal Wall ◽  
Case Series ◽  
Muscle Thickness ◽  
Component Separation ◽  
Fascial Closure ◽  
Lateral Abdominal Wall ◽  
Transverse Abdominis ◽  
Abdominal Wall Muscle ◽  
Anterior Component Separation

Abstract Aim Effects of component separation (CS) on abdominal wall musculature have only been investigated in smaller case series. The study aimed to compare abdominal wall alterations following endoscopic anterior component separation (EACS) or transverse abdominis release (TAR). Material and Methods Computed tomography scans were evaluated in patients who underwent open ventral hernia repair with TAR or EACS. Lateral abdominal wall muscle thickness and displacement were compared with preoperative images after bilateral CS and the undivided side postoperatively after unilateral CS. Results In total, 105 patients were included. The mean defect width was 12.2 cm. Fifty-five (52%) and 15 (14%) underwent bilateral and unilateral EACS, respectively. Five (5%) and 14 (13%) underwent bilateral and unilateral TAR, respectively. Sixteen (15%) underwent unilateral EACS and contralateral TAR. Complete fascial closure was achieved in 103 (98%) patients. The external oblique and transverse abdominis muscles were significantly laterally displaced with a mean of 2.74 cm (95% CI 2.29-3.19 cm) and 0.82 cm (0.07-1.57 cm) after EACS and TAR, respectively. The combined thickness of the lateral muscles was significantly decreased after EACS (mean decrease 10.5% [5.8-15.6%]) and insignificantly decreased after TAR (mean decrease 2.6% [-4.8-9.5%]), mean reduction difference EACS versus TAR 0.22 cm (-0.01-0.46 cm). One (1%) patient developed an iatrogenic linea semilunaris hernia after EACS. The recurrence rate was 19% after mean 1.7 years follow-up. Conclusions The divided muscle was significantly more laterally displaced after EACS compared with TAR. The thickness of the lateral muscles was slightly decreased after EACS and unchanged after TAR.

Operative Outcomes after Open Abdominal Wall Reconstruction with Retromuscular Mesh Fixation Using Fibrin Glue versus Transfascial Sutures

2017 ◽  
Vol 83 (9) ◽  
pp. 937-942 ◽  
Author(s):  
Adam S. Weltz ◽  
Udai S. Sibia ◽  
H. Reza Zahiri ◽  
Alexa Schoeneborn ◽  
Adrian Park ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Abdominal Wall ◽  
Fibrin Glue ◽  
Mesh Fixation ◽  
Abdominal Wall Reconstruction ◽  
Safe Alternative ◽  
Operative Outcomes ◽  
Fixation Techniques

Ideal fixation techniques have not been fully elucidated at the time of complex open abdominal wall reconstruction (AWR). We compared operative outcomes and quality of life with retromuscular mesh fixation using fibrin glue (FG) versus transfascial sutures (TS). Retrospective review identified complex hernia patients who underwent open AWR with mesh from November 2012 through April 2016. Multivariate analysis examined postoperative outcomes between groups. Quality of life was assessed using the Carolinas Comfort Scale. Seventy-five patients (18 FG vs 57 TS) with mean age (54.3 vs 53.9 years, P = 0.914), body mass index (35.8 vs 34.7 kg/m2, P = 0.623) and American Society of Anesthesiologist score (2.6 vs 2.5, P = 0.617) were reviewed. No differences in wound (P = 0.072) and nonwound (P = 0.639) related complications were noted between groups. Risk of reoperations (P = 0.275) and 30-day readmissions (P = 0.137) were also comparable. The TS group was twelve times more likely to report pain at six-month follow-up compared with FG (12.29 OR, 95 per cent confidence interval 1.26–120.35, P = 0.031). No hernia recurrences were noted in either group at a mean follow-up of 390 ± 330 days. The use of FG to secure mesh in the retromuscular space during complex open AWR may be a safe alternative to penetrating transfascial fixation with potential to reduce chronic pain.

scholarly journals Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement

BJS Open ◽  
2021 ◽  
Vol 5 (5) ◽  
Author(s):  
T N Grove ◽  
C Kontovounisios ◽  
A Montgomery ◽  
B T Heniford ◽  
A C J Windsor ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Preoperative Assessment ◽  
Life Assessment ◽  
Response Analysis ◽  
Delphi Consensus ◽  
Web Based ◽  
Midline Laparotomy

Abstract Background The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20–41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection, management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide a clear benchmark of care for the preoperative assessment and perioperative optimization of patients undergoing AWR. Methods The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirty-two hernia surgeons from recognized hernia societies globally took part. The process included two rounds of anonymous web-based voting with response analysis and formal feedback, concluding with a live round of voting followed by discussion at an international conference. Consensus for a strong recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per cent agreement. Results Consensus was obtained on 52 statements including surgical assessment, preoperative assessment, perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment. Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement. Conclusion Clear consensus recommendations from a global group of experts in the AWR field are presented in this study. These should be used as a baseline for surgeons and centres managing abdominal wall hernias and performing complex AWR.

scholarly journals ABDOMINAL WALL RECONSTRUCTION BY BILATERAL TRANSVERSUS ABDOMINIS RELEASE – A MASTERLY PROCEDURE

2020 ◽  
pp. 10-11
Author(s):  
Anirban Bhunia ◽  
Soumyajyoti Panja
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Component Separation ◽  
Transversus Abdominis ◽  
Abdominal Hernia ◽  
Posterior Component Separation ◽  
Loss Of Domain ◽  
Ventral Incisional Hernia ◽  
Operative Recovery ◽  
Transversus Abdominis Muscle

BACKGROUND: In ventral hernia repair, closure of the defect is one of the most significant challenges, especially in a wide defect, large hernias with loss of domain, and recurrent hernias. Posterior component separation with transverses abdominis muscle release (TAR) is a novel approach that offers a solution for complex ventral hernias. AIMS AND OBJECTIVES: To assess the clinical effectiveness of posterior abdominal wall components separation with transversus abdominis muscle release (PCS-TAR) in the management of ventral abdominal hernia with loss of domain. METHOD: The posterior component separation by transversus abdominis muscle release (simply TAR) is a modification of the Rives-Stoppa procedure which combines it with developing of a large retro-muscular/pre-peritoneal plane and a consistent medial advancement of the abdominal wall musculature and accompanying fascia. This preserves the neurovascular bundles innervating the medial abdominal wall. Mesh is placed in a sublay fashion above the posterior layer. In an overwhelming majority of patients, the linea alba is reconstructed, creating a functional abdominal wall with wide mesh reinforcement. RESULT: We used this procedure in a case of large median ventral incisional hernia. Our patient was a known post-operative case of exploratory laparotomy for ileal perforation following blunt abdominal trauma. Ileostomy was done due to gross intraperitoneal contamination. His post-operative recovery was complicated by wound dehiscence previously. Patient presented with a hernia along the midline wound with a gap of 12*7 cm. After the abdominal wall reconstruction procedure (TAR) with mesh placement over posterior rectus sheath (15*20cm) his post op recovery was uneventful. There was no recurrence till follow up of 3 months. CONCLUSION: TAR seems to be the effective approach for complex hernias with good immediate outcomes.

scholarly journals Robotic hernia repair

Der Chirurg ◽  
2021 ◽  
Author(s):  
Ulrich A. Dietz ◽  
O. Yusef Kudsi ◽  
Miguel Garcia-Ureña ◽  
Johannes Baur ◽  
Michaela Ramser ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Component Separation ◽  
Transversus Abdominis ◽  
Nerve Sparing ◽  
Complication Rates ◽  
Robotic Hernia Repair ◽  
Lower Complication ◽  
Anterior Component Separation ◽  
Abdominal Reconstruction

AbstractThe principle of targeted separation or weakening of individual components of the abdominal wall to relieve tension in the median line during major abdominal reconstruction has been known for over 30 years as anterior component separation (aCS) and is an established procedure. In search of alternatives with lower complication rates, posterior component separation (pCS) was developed; transversus abdominis release (TAR) is a nerve-sparing modification of pCS. With the ergonomic resources of robotics (e.g., angled instruments), TAR can be performed in a minimally invasive manner (r-TAR): hernia gaps of up to 14 cm can be closed and a large extraperitoneal mesh implanted. In this video article, the treatment of large incisional hernias using the r‑TAR technique is presented. Exemplary results of a cohort study in 13 consecutive patients are presented. The procedure is challenging, but our own results—as well as reports from the literature—are encouraging. The r‑TAR is becoming the pinnacle procedure for abdominal wall reconstruction.

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