Comparison of the outcomes of ‘component separation with mesh’, ‘component separation without mesh’ and ‘primary prosthetic repair’ methods in complex abdominal wall reconstruction

Abstract Aim Aim of the analysis was to evaluate whether preoperative botulinum toxin infiltration may facilitate anatomical midline reconstruction without the need for – otherwise pre-operative assumed – surgical component separation. Material and Methods Total of 58 patients with complex abdominal wall hernias were included in our single-center retrospective analysis between 03/2015 and 12/2020. Size of the defect, HSV/ACV-ratio, rectus-to-defect-width-ratio (“Carbonell-Index”) as well as risk factors were analyzed. In all patients muscles of the lateral abdominal wall were infiltrated with 300-500 IE of botulinum toxin 4 weeks prior to the abdominal wall reconstruction. CT scans were performed before and 4 weeks after the botulinum toxin infiltration. Results Total of 58 patients (M/F-ratio 36:22), with a mean age of 63.8 years were included in our analysis. Mean BMI was 29.5 kg/m². Total of 50 incisional, 3 umbilical, 2 posttraumatic diaphragmatic hernias and 3 scrotal hernias were analyzed. Surgical component separation after the infiltration with botulinum toxin was necessary in 43% of the cases. Conclusions Preoperative infiltration of the lateral abdominal wall musculature with botulinum toxin facilitated midline reconstruction of the abdominal wall without the need for myofascial release in 57%. Reduction of surgical trauma could therefore be achieved in several patients.

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Tensiometry as a Decision Tool for Abdominal Wall Reconstruction with Component Separation

World Journal of Surgery ◽

10.1007/s00268-009-9991-8 ◽

2009 ◽

Vol 33 (6) ◽

pp. 1174-1180 ◽

Cited By ~ 28

Author(s):

Adrian Dragu ◽

Peter Klein ◽

Frank Unglaub ◽

Elias Polykandriotis ◽

Ulrich Kneser ◽

...

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

Decision Tool

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Concomitant Anterior and Posterior Component Separations: Absolutely Contraindicated?

Surgical Innovation ◽

10.1177/1553350620914195 ◽

2020 ◽

pp. 155335062091419

Author(s):

Jorge Daes ◽

Joshua S. Winder ◽

Eric M. Pauli

Keyword(s):

Abdominal Wall ◽

Lateral Displacement ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

Transversus Abdominis ◽

Lateral Abdominal Wall ◽

Computed Tomography Images ◽

Fresh Cadaver ◽

Semilunar Line ◽

Internal Oblique

Many experts in abdominal wall reconstruction believe that the combination of simultaneous ipsilateral anterior component separation (ACS) and posterior component separation (PCS) is contraindicated. We performed ipsilateral endoscopic ACS and either endoscopic or open PCS-transversus abdominis release (TAR) in 5 fresh cadaver models. The full length of the semilunar line and the lateral abdominal wall remained well reinforced by 2 complete layers, comprising the internal oblique (IO) and TA muscles and their investing fasciae. Myofascial releases occurred 4 cm (median) apart. Additionally, we reviewed computed tomography images at 1 month and 1 year after PCS-TAR in 17 patients (30 PCS-TARs). Lateral displacement of the TA relative to the rectus abdominis (RA) was significant only at the superior mesenteric artery level, where it was <1 cm (median). Muscle mass changed minimally over time. Several studies showed that abdominal wall reconstruction after PCS-TAR results in compensatory muscular hypertrophy of the RA, external oblique (EO), and IO muscles and provides better quality of life and improved core physiology. These changes did not occur when the midline was not restored. Theoretically, endoscopic ACS-EO may be added to PCS-TAR to avoid partially bridged mesh repair in patients in whom complete midline restoration is impossible via PCS-TAR alone. Nevertheless, we advise most surgeons to perform a small-bridged repair instead of risking increased morbidity by attempting a highly complicated procedure.

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A population-level analysis of abdominal wall reconstruction by component separation in the morbidly obese patient: Can it be performed safely?

Journal of Plastic Surgery and Hand Surgery ◽

10.3109/2000656x.2014.880350 ◽

2014 ◽

Vol 48 (5) ◽

pp. 305-311 ◽

Cited By ~ 8

Author(s):

Jonas A. Nelson ◽

John P. Fischer ◽

Jason D. Wink ◽

Stephen J. Kovach

Keyword(s):

Obese Patient ◽

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Population Level ◽

Component Separation ◽

Morbidly Obese ◽

Morbidly Obese Patient ◽

Level Analysis

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Minimally Invasive Component Separation Improves Surgical Outcomes for Abdominal Wall Reconstruction in High-Risk Patients

Plastic & Reconstructive Surgery ◽

10.1097/01.prs.0000406298.93155.45 ◽

2011 ◽

Vol 128 ◽

pp. 73

Author(s):

Shadi Ghali ◽

Kristin Campbell ◽

Donald Baumann ◽

Charles Butler

Keyword(s):

High Risk ◽

Minimally Invasive ◽

Abdominal Wall ◽

Surgical Outcomes ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

High Risk Patients ◽

Invasive Component ◽

Risk Patients

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P015 ABDOMINAL WALL PREPARATION PRECEDING COMPLEX ABDOMINAL WALL RECONSTRUCTION (CAWR) - SINGLE CENTER INITIAL EXPERIENCES UTILIZING BOTULINUM TOXIN A (BTA) ACCOMPANIED IN SELECTED PATIENTS BY PREOPERATIVE PROGRESSIVE PNEUMOPERITONEUM (PPP)

British Journal of Surgery ◽

10.1093/bjs/znab395.014 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Henrik Husu ◽

Sanna Valle ◽

Tom Scheinin ◽

Jaana Vironen

Keyword(s):

Abdominal Wall ◽

Botulinum Toxin A ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

Fascial Closure ◽

Abdominal Wall Defects ◽

Closure Rate ◽

Loss Of Domain ◽

Lateral Abdominal Wall ◽

Preoperative Progressive Pneumoperitoneum

Abstract Aim Complex ventral hernia (CVH) treatment due to large abdominal wall defects or loss of domain is challenging. BTA-injection in lateral abdominal wall causing flaccid paralysis and elongation, so called chemical component separation (CCS), might facilitate closure of large fascial defects. Combining preoperative progressive pneumoperitoneum might help restore abdominal content in severe loss of domain situations. We studied the results after CAWR following abdominal wall preparation with BTA and possible PPP. Primary aim was to report fascial defect closure rate without need for surgical component separation. Material and Methods All electively operated patients to date that were treated preoperatively with BTA, including all patients treated with PPP. Results Hospital index patient received preoperative BTA in January 2018. Since then, altogether 42 patients underwent CCS prior to CAWR. Average patient suffered from obesity (mean BMI 31), 30% had diabetes, and a third were active smokers. Mean hernia defect area exceeded 200 cm2. All operations were mesh repairs. Surgical approach was mostly (88%) open retromuscular. Abdominal wall reconstruction via fascial closure was achieved in 93% of cases with only 21% needing surgical component separation. Preoperative morbidity was common in patients undergoing PPP. Around 40% of all patients had postoperative complications, half of which were surgical complications. One patient died of a yet unknown cause on the third postoperative day. There were no recurrences within median 15 months follow-up. Conclusions Restoring abdominal wall continuity without frequent need for surgical component separation seems likely in CVH following CCS.

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