Components Separation: A Solution to Complex Abdominal Wall Defects

Complex abdominal wall hernias can be challenging to treat. The purpose of this study was to retrospectively review the results of components separation. Seventeen patients underwent components separation between 2000 and 2007. Mean size of the hernia defect was 318 cm2. Mean number of prior abdominal operations/patient was 3.2. Nine patients (53%) had prior failed repair. At time of components separation, five patients (29%) had concurrent gastrointestinal operations and two (12%) had panniculectomy. Mean hospitalization stay was 3.8 days with a readmission rate of 41 per cent. The most common postoperative complications were wound related and occurred in 35 per cent of patients. During a mean follow-up of 21 months, only one patient had recurrent hernia (6%). Five patients (29%) required additional operations. Components separation is a viable option for patients with complex abdominal wall defects. Long-term recurrence is rare but wound related complications, operative reinterventions, and hospital readmission are common.

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Closure of Chronic Abdominal Wall Defects: A Long-term Evaluation of the Components Separation Method

Annals of Plastic Surgery ◽

10.1097/00000637-199904000-00007 ◽

1999 ◽

Vol 42 (4) ◽

pp. 385-395 ◽

Cited By ~ 81

Author(s):

John A. Girotto ◽

Marcus J. Ko ◽

Rick Redett ◽

Thomas Muehlberger ◽

Mark Talamini ◽

...

Keyword(s):

Abdominal Wall ◽

Separation Method ◽

Abdominal Wall Defects ◽

Components Separation ◽

Term Evaluation ◽

Components Separation Method

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Intraperitoneal Tension-free Repair of a Small Midline Ventral Abdominal Wall Hernia: Randomized Study with a Mean Follow-up of 3 Years

The American Surgeon ◽

10.1177/000313481408000125 ◽

2014 ◽

Vol 80 (1) ◽

pp. 57-65 ◽

Cited By ~ 5

Author(s):

Hocine Bensaadi ◽

Luca Paolino ◽

Antonio Valenti ◽

Claude Polliand ◽

Christophe Barrat ◽

...

Keyword(s):

Hernia Repair ◽

Abdominal Wall ◽

Randomized Study ◽

Abdominal Wall Hernia ◽

Late Complications ◽

Abdominal Wall Defects ◽

Complication Rates ◽

Surgeon Experience

Funding received from Cousin Biotech, Wervicq Sud, France, and CR Bard Inc., Cranston, RI. The aim of this prospective randomized study was to determine the long-term recurrence and complication rates after small abdominal wall hernia repair with two different bilayer prostheses. Hernia repair using prosthetic mesh material has become the preferred method of repair, because the recurrence rates are much lower than with conventional repair techniques. The use of a hernia bilayer patch, composite expanded polytetrafluoroethylene (ePTFE)-polypropylene, with intraperitoneal placement behind the hernia defect, through a small incision, may be efficient, safe, and cost-effective. This study is a randomized, single-institution trial, including 83 selected consecutive patients with primary (umbilical, epigastric) or incisional anterior abdominal wall defects from 2 to 5 cm. Hernia repair was performed by direct local access in ambulatory surgery; the prosthesis used was a circular bilayer with an inner face in ePTFE to avoid bowel adhesion. One group was treated with a Ventralex® Hernia Patch (Bard USA). The second group was treated with a Cabs'Air® Composite (Cousin Biotech France), which was delivered with two to four fixation sutures and a balloon to properly deploy the mesh intraperitoneally. Patients’ characteristics and operative and postoperative data were prospectively collected. The primary outcome was late recurrence. Secondary outcomes included, pain, discomfort and quality of life before and after (3 months) surgery using the SF-12 questionnaire, patient-surgeon satisfaction, and early and late complications. Among 98 patients, 83 were included in the study protocol between January 2007 and August 2011. The two groups were comparable according to pre- and intraoperative data. According to surgeon experience, placement of the Cabs'Air® device was significantly faster ( P = 0.01) and easier. At 3 months, there was significantly less pain and less discomfort for the Cabs'Air® group and patient satisfaction rate was higher. This was confirmed by all components of the SF-12 questionnaire. Long-term follow-up was available for 77 patients. The mean follow-up was similar for the two groups (42 months; range, 14 to 70 months). At this point, for the Ventralex® group, there were four recurrences (11.7%); one mesh infection; one small bowel obstruction; and six cases (15.7%) of severe pain resulting from a mass syndrome (shrinkage) with a sense of the presence of a foreign body. Six reoperations (15.6%) were required with explant of the prosthesis. There were no recurrences or late complications in the comparative group. The Ventralex® Hernia Patch is associated with inconsistent deployment, spreading, or shrinkage, which account for late complications and decreases the overlap, which contributes to the recurrence rate. The Cabs'Air®-associated balloon facilitates superior deployment of the prosthesis allowing for good fixation with four sutures.

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Outcomes of Incisional Hernia Repair Surgery After Multiple Re-recurrences: A Propensity Score Matched Analysis

World Journal of Surgery ◽

10.1007/s00268-021-05952-5 ◽

2021 ◽

Author(s):

Dimitri Sneiders ◽

Gijs H. J. de Smet ◽

Floris den Hartog ◽

Yagmur Yurtkap ◽

Anand G. Menon ◽

...

Keyword(s):

Propensity Score ◽

Incisional Hernia ◽

Incisional Hernia Repair ◽

Recurrent Hernia ◽

Control Group ◽

Baseline Characteristics ◽

Biological Situation ◽

Similar Risk

Abstract Background Patients with a re-recurrent hernia may account for up to 20% of all incisional hernia (IH) patients. IH repair in this population may be complex due to an altered anatomical and biological situation as a result of previous procedures and outcomes of IH repair in this population have not been thoroughly assessed. This study aims to assess outcomes of IH repair by dedicated hernia surgeons in patients who have already had two or more re-recurrences. Methods A propensity score matched analysis was performed using a registry-based, prospective cohort. Patients who underwent IH repair after ≥ 2 re-recurrences operated between 2011 and 2018 and who fulfilled 1 year follow-up visit were included. Patients with similar follow-up who underwent primary IH repair were propensity score matched (1:3) and served as control group. Patient baseline characteristics, surgical and functional outcomes were analyzed and compared between both groups. Results Seventy-three patients operated on after ≥ 2 IH re-recurrences were matched to 219 patients undergoing primary IH repair. After propensity score matching, no significant differences in patient baseline characteristics were present between groups. The incidence of re-recurrence was similar between groups (≥ 2 re-recurrences: 25% versus control 24%, p = 0.811). The incidence of complications, as well as long-term pain, was similar between both groups. Conclusion IH repair in patients who have experienced multiple re-recurrences results in outcomes comparable to patients operated for a primary IH with a similar risk profile. Further surgery in patients who have already experienced multiple hernia re-recurrences is justifiable when performed by a dedicated hernia surgeon.

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Long-Term Clinical Outcomes of an Antibiotic-Coated Non–Cross-linked Porcine Acellular Dermal Graft for Abdominal Wall Reconstruction for High-Risk and Contaminated Wounds

The American Surgeon ◽

10.1177/00031348211023392 ◽

2021 ◽

pp. 000313482110233

Author(s):

Jordan Robinson ◽

Jesse K. Sulzer ◽

Benjamin Motz ◽

Erin H. Baker ◽

John B. Martinie ◽

...

Keyword(s):

High Risk ◽

Abdominal Wall ◽

Clinical Outcomes ◽

Open Abdomen ◽

Abdominal Wall Reconstruction ◽

Dermal Graft ◽

Elective Repair ◽

Acellular Dermal

Background Abdominal wall reconstruction in high-risk and contaminated cases remains a challenging surgical dilemma. We report long-term clinical outcomes for a rifampin-/minocycline-coated acellular dermal graft (XenMatrix™ AB) in complex abdominal wall reconstruction for patients with a prior open abdomen or contaminated wounds. Methods Patients undergoing abdominal wall reconstruction at our institution at high risk for surgical site occurrence and reconstructed with XenMatrix™ AB with intent-to-treat between 2014 and 2017 were included. Demographics, operative characteristics, and outcomes were collected. The primary outcome was hernia recurrence. The secondary outcomes included length of stay, surgical site occurrence, readmission, morbidity, and mortality. Results Twenty-two patients underwent abdominal wall reconstruction using XenMatrix™ AB during the study period. Two patients died while inpatient from progression of their comorbid diseases and were excluded. Sixty percent of patients had an open abdomen at the time of repair. All patients were from modified Ventral Hernia Working Group class 2 or 3. There were a total of four 30-day infectious complications including superficial cellulitis/fat necrosis (15%) and one intraperitoneal abscess (5%). No patients required reoperation or graft excision. Median clinical follow-up was 38.2 months with a mean of 35.2 +/− 18.5 months. Two asymptomatic recurrences and one symptomatic recurrence were noted during this period with one planning for elective repair of an eventration. Follow-up was extended by phone interview which identified no additional recurrences at a median of 45.5 and mean of 50.5 +/−12.7 months. Conclusion We present long-term outcomes for patients with high-risk and contaminated wounds who underwent abdominal wall reconstruction reinforced with XenMatrix™ AB to achieve early, permanent abdominal closure. Acceptable outcomes were noted.

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Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty

Clinical Infectious Diseases ◽

10.1093/cid/ciz867 ◽

2019 ◽

Vol 71 (3) ◽

pp. 630-636 ◽

Cited By ~ 3

Author(s):

Claudia A M Löwik ◽

Javad Parvizi ◽

Paul C Jutte ◽

Wierd P Zijlstra ◽

Bas A S Knobben ◽

...

Keyword(s):

Treatment Failure ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Viable Option ◽

Time Intervals ◽

Implant Retention ◽

Time Point ◽

Viable Treatment

Abstract Background The success of debridement, antibiotics, and implant retention (DAIR) in early periprosthetic joint infection (PJI) largely depends on the presence of a mature biofilm. At what time point DAIR should be disrecommended is unknown. This multicenter study evaluated the outcome of DAIR in relation to the time after index arthroplasty. Methods We retrospectively evaluated PJIs occurring within 90 days after surgery and treated with DAIR. Patients with bacteremia, arthroscopic debridements, and a follow-up <1 year were excluded. Treatment failure was defined as (1) any further surgical procedure related to infection; (2) PJI-related death; or (3) use of long-term suppressive antibiotics. Results We included 769 patients. Treatment failure occurred in 294 patients (38%) and was similar between time intervals from index arthroplasty to DAIR: the failure rate for Week 1–2 was 42% (95/226), the rate for Week 3–4 was 38% (143/378), the rate for Week 5–6 was 29% (29/100), and the rate for Week 7–12 was 42% (27/65). An exchange of modular components was performed to a lesser extent in the early post-surgical course compared with the late course (41% vs 63%, respectively; P < .001). The causative microorganisms, comorbidities, and durations of symptoms were comparable between time intervals. Conclusions DAIR is a viable option in patients with early PJI presenting more than 4 weeks after index surgery, as long as DAIR is performed within at least 1 week after the onset of symptoms and modular components can be exchanged.

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Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

European Journal of Ophthalmology ◽

10.1177/1120672120976044 ◽

2020 ◽

pp. 112067212097604

Author(s):

Reem R Al Huthail ◽

Yasser H Al-Faky

Keyword(s):

Chart Review ◽

Retrospective Chart Review ◽

Tertiary Hospital ◽

Nasal Endoscope ◽

Long Term Follow Up ◽

Mean Size ◽

External Dacryocystorhinostomy ◽

The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

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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

Surgical Innovation ◽

10.1177/15533506211041477 ◽

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.

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“componenTs separaTion” meThod for cLosUre of aBdominaL- waLL defecTs: an anaTomic and cLinicaL sTUdy

50 Studies Every Plastic Surgeon Should Know ◽

10.1201/b17524-35 ◽

2014 ◽

pp. 219-224

Keyword(s):

Clinical Study ◽

Abdominal Wall ◽

Separation Method ◽

Abdominal Wall Defects ◽

Components Separation ◽

Components Separation Method

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P011 THE EARLY OUTCOMES OF ABDOMINAL WALL RECONSTRUCTION WITH POLYVINYLIDENE (PVDF) MESH IN THE INFECTED SETTING: A CASE-CONTROL SERIES

British Journal of Surgery ◽

10.1093/bjs/znab395.010 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Claudio Birolini ◽

Eduardo Tanaka ◽

Jocielle Miranda ◽

Abel Murakami ◽

Edivaldo Utiyama

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Synthetic Mesh ◽

Tissue Response ◽

Abdominal Wall Defects ◽

Chronic Infections ◽

Control Series ◽

Elective Setting ◽

Abdominal Operations ◽

Low Incidence

Abstract Aim The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. Material and Methods A prospective clinical trial started in 2016 and designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects. Results Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and a longer operative and anesthesia time. At 30-days, surgical site occurrences were observed in 18 (47.4%) AI vs. 17 (44.7%) CC; surgical site infection occurred in 4 (10.4%) AI vs. 6 (15.8%) CC, and a higher number of procedural interventions were required in the CC group, 15.8% AI vs. 28.9% CC. At 6-months follow-up, no chronic infections or hernia recurrences were observed in both groups. Conclusions The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.

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