Prospective study of midline abdominal incisional hernia repair by component separation technique augmented with prosthetic mesh

Background: In our tertiary care hospital, we receive a large number of acute abdomen cases. Raised intra-abdominal pressure (IAP) makes laparostomy mandatory initially and abdominal wall approximation cannot be completed due to compromised state in most cases. Large incisional hernias were seen on complete healing and this study was done to see the feasibility of component separation technique (CST) with mesh augmentation.Methods: 30 patients were subjected to CST with mesh augmentation. Preoperative defect size mapping, Pre- and post-operative monitoring of IAP were done. Pain scoring by visual analogue scale (VAS), early and late complications was noted. Patients were followed up for 60 months.Results: CST with mesh augmentation was found to be feasible with 96.77% success rate as no recurrence was noted in follow up. Preoperative average Basal metabolic index was 26.09. Size of defect varied from 17-20×9-16 cm2 (length X width). Seroma seen in 50% of patients was managed without any intervention. Skin necrosis in 6.6% and wound dehiscence in 3.33%, managed with minimal debridement & local wound care respectively. Respiratory compromise and hematoma were not seen and no patient required any active ICU care. Average length of hospital stay was 5.22 days. Close monitoring of IAP in immediate post-operative period was found to be significant.Conclusion: Physical acceptance of stable abdominal wall gives a psychological boost to patients with early recovery in form of ambulation and early return to work.

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SHOULD QUALITY OF LIFE BE A CONSIDERATION TO OPERATE LARGE VENTRAL HERNIAS: A PROSPECTIVE STUDY

10.36106/paripex/0406760 ◽

2021 ◽

pp. 13-16

Author(s):

Aslam Baba Diamond ◽

Vikas Singhal ◽

Amanjeet Singh ◽

Azhar Perwaiz ◽

Adarsh Chaudhary

Keyword(s):

Quality Of Life ◽

Abdominal Wall ◽

Tertiary Care ◽

Component Separation ◽

Separation Technique ◽

Care Hospital ◽

Size Estimation ◽

Component Separation Technique ◽

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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