Multipoint Suture Fixation Technique for Abdominal Wall Reconstruction with Component Separation and Onlay Biological Mesh Placement

2017 ◽  
Vol 83 (5) ◽  
pp. 515-521 ◽  
Author(s):  
Brad Denney ◽  
Jorge I. De Latorre
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Component Separation ◽  
Biologic Mesh ◽  
Primary Data ◽  
Suture Fixation ◽  
Fixation Technique ◽  
Recurrence Rates ◽  
Mesh Placement

Component separation with mesh reinforcement has become the primary modality for complex abdominal wall reconstruction. However, many fundamental questions remain unanswered, such as whether underlay versus overlay mesh placement is superior, and what is the best means of suture fixation technique for mesh placement? This study presents the senior author's technique for onlay biologic mesh placement with multipoint suture fixation in combination with component separation and its subsequent low recurrence rates. This is a retrospective review of the senior author's cases of component separation with onlay biologic mesh placement during his tenure at the home institution of the University of Alabama at Birmingham. A total of 75 patients were included, all of whom underwent complex abdominal wall reconstruction from September 2002 to April 2012. Patients were excluded from the dataset if their surgery occurred less than two years before date of data collection to give a minimum 2-year follow-up. Patients were identified by Current Procedural Terminology codes for component separation and their charts reviewed by the home institution's electronic medical record. Data point entries included patient demographics and comorbidities, concomitant procedures such as bowel resection or panniculectomy, and characteristics of the reconstruction such as type of mesh used. Primary data endpoints were complications following surgery, particularly recurrence and laxity. A total of 75 patients were included in the study from September 2002 to April 2012 with a minimum 2-year follow-up period. The recurrence rate was 13 per cent and the rate of laxity 2.7 per cent. There was one death (1.35%). The most frequent complication was seromas at a rate of 17 per cent. Multipoint fixation suture technique for abdominal wall reconstruction with component separation and onlay biologic mesh is a reproducible technique with reliably low recurrence rates.

Value Improvement and Resource Utilization in Complex Abdominal Wall Reconstruction

2019 ◽  
Vol 85 (10) ◽  
pp. 1113-1117 ◽  
Author(s):  
Cory K. Mayfield ◽  
Daniel J. Gould ◽  
Alex Wong ◽  
Ketan M. Patel ◽  
Joseph Carey
Keyword(s):  
Abdominal Wall ◽  
Recurrence Rate ◽  
Abdominal Wall Reconstruction ◽  
Synthetic Mesh ◽  
Low Risk ◽  
Biologic Mesh ◽  
Institutional Pressures ◽  
Recurrence Rates ◽  
Significant Difference ◽  
Risk Patients

Although recommendations help guide surgeons’ mesh choice in abdominal wall reconstruction (AWR), financial and institutional pressures may play a bigger role. Standardization of an AWR algorithm may help reduce costs and change mesh preferences. We performed a retrospective review of high- and low-risk patients who underwent inpatient AWR between 2014 and 2016. High risk was defined as immunosuppression and/or history of infection/contamination. Patients were stratified by the type of mesh as biologic/biosynthetic or synthetic. These cohorts were analyzed for outcome, complications, and cost. One hundred twelve patients underwent complex AWR. The recurrence rate at two years was not statistically different between high- and low-risk cohorts. No significant difference was found in the recurrence rate between biologic and synthetic meshes when comparing both high- and low-risk cohorts. The average cost of biologic mesh was $9,414.80 versus $524.60 for synthetic. The estimated cost saved when using synthetic mesh for low-risk patients was $295,391.20. In conclusion, recurrence rates for complex AWR seem to be unrelated to mesh selection. There seems to be an excess use of biologic mesh in low-risk patients, adding significant cost. Implementing a critical process to evaluate indications for biologic mesh use could decrease costs without impacting the quality of care, thus improving the overall value of AWR.

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.

The Case for Onlay Biologic Mesh in Abdominal Wall Reconstruction Using Progressive Tension Suture Fixation

2021 ◽  
Vol 86 (6S) ◽  
pp. S498-S502
Author(s):  
John T. Lindsey ◽  
Carter J. Boyd ◽  
Claire Davis ◽  
John Wilson ◽  
Srikanth Kurapati ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Biologic Mesh ◽  
Suture Fixation

scholarly journals P014 COMPARATIVE EFFECTIVENESS OF RESORBABLE SYNTHETIC ONLAY AND BIOLOGIC INTRAPERITONEAL MESH FOR ABDOMINAL WALL RECONSTRUCTION: A 2-YEAR MATCHED PAIR ANALYSIS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Sammy Othman ◽  
Adrienne Christopher ◽  
Viren Patel ◽  
Hanna Jia ◽  
Joseph Mellia ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Relative Effectiveness ◽  
Abdominal Wall Reconstruction ◽  
Synthetic Mesh ◽  
Biologic Mesh ◽  
Matched Pair ◽  
Recurrence Rates ◽  
Matched Pair Analysis ◽  
Operative Outcomes ◽  
Clean Contaminated

Abstract Aim The literature currently lacks comparative studies examining the relative effectiveness of anatomic planes and mesh selection when combating abdominal wall reconstruction (AWR), particularly when the retrorectus sublay space is not available. The aim of this study was to examine the efficacy of resorbable synthetic mesh onlay (RSOM) plane against biologic mesh in the intraperionteal plane (BIPM). Methods A single center, two surgeon, 5-year retrospective review (2014-2019) was performed examining subjects who underwent AWR in the onlay plane with resorbable synthetic mesh or the intraperitoneal plane with biologic mesh. A matched paired analysis was conducted. Data examining demographic characteristics, intraoperative variables, post-operative outcomes, and costs were analyzed. Results A total of 88 subjects (44 per group) were identified (median follow-up: 24.5 months). The mean age was 57.7 years, with a mean BMI of 30.4 kg/m2. The average defect size was 292 ± 237 cm2, with most wounds being clean-contaminated (48.9%), and 55% having prior failed repair. RSOM subjects were significantly less likely (4.5%) to experience recurrence compared to BIPM (22.7%; p<0.026.). Additionally, RSOM suffered less post-operative surgical site occurrences (18.2% vs. 40.9%;p<0.019) and required fewer procedural interventions (11.4% vs. 36.4%;p<0.011). RSOM was also associated with significantly less total costs ($16,658 ± 14,930) compared to BIPM ($27,645 ± 16,864;p<0.001). Conclusion When faced with hernia repair, the selection of resorbable synthetic mesh in the onlay plane may be preferable to biologic mesh place in the intraperitoneal plane due to lower long-term recurrence rates, surgical site complications, and costs.

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

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.

Biologic mesh is non-inferior to synthetic mesh in CDC class 1 & 2 open abdominal wall reconstruction

2021 ◽  
Author(s):  
Jenny M. Shao ◽  
Sullivan A. Ayuso ◽  
Eva B. Deerenberg ◽  
Sharbel A. Elhage ◽  
Tanu Prasad ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Synthetic Mesh ◽  
Biologic Mesh ◽  
Class 1

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.

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