Top

Hernia

Published in:

01-04-2016 | Original Article

A stepwise approach based on a rational use of components separation and double mesh prosthesis for incisional hernia repair

Authors: Á. Celdrán, M. J. Fraile, T. Georgiev-Hristov, S. González-Ayora

Published in: Hernia | Issue 2/2016

Abstract

Purpose

We aimed to evaluate the results of a protocol for a tension-free reconstruction of the abdominal wall in midline incisional hernia repair, based on the rational association of components separation and prosthesis, independently of the hernia size.

Methods

A total of 100 consecutive patients with midline incisional hernias were prospectively included in the study. Three groups according to the transverse diameter of the defect [group A (<4 cm, N = 18), group B (4–10 cm, N = 59), and group C (>10 cm, N = 23)] were identified.

Results

Components separation was necessary in 54 % of the patients: 16.7 % (3/18) in group A, 59.3 % (35/59) in group B, and 69.6 % (16/23) in group C. Complete tension-free reconstruction was achieved in 87 % of the patients: 94.4 % (17/18) in group A, 91.5 % (54/59) in group B, and 69.6 % (16/23) in group C. Overall morbidity rate was 21 % (21/100) [group A 16.7 % (3/18), group B 22 % (13/59), and group C 21.7 % (5/23)]. Hospital length of stay was 3.7 ± 3.3 days (group A 1.83 ± 1.43 days, group B 3.05 ± 2.11 days, and group C 6.91 ± 4.45 days). Median follow-up was 25 months (interquartile range 12.25–55.25) with overall recurrence of 2 %.

Conclusion

A tension-free abdominal wall reconstruction can be achieved in most cases of small and large midline incisional hernia repair, by a stepwise approach based on a rational association of components separation and double mesh prosthesis, with a low morbidity and recurrence rates.

Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72(1):70–71PubMedCrossRef

Schoetz DJ Jr, Coller JA, Veidenheimer MC (1988) Closure of abdominal wounds with polydioxanone. A prospective study. Arch Surg (Chicago, Ill : 1960) 123 (1):72–74

Santora TA, Roslyn JJ (1993) Incisional hernia. Surg Clin N Am 73(3):557–570PubMed

Usher FC (1971) The repair of incisional and inguinal hernias. Tex Med 67(11):106–111PubMed

Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343(6):392–398. doi:10.1056/nejm200008103430603 PubMedCrossRef

Voyles CR, Richardson JD, Bland KI, Tobin GR, Flint LM, Polk HC Jr (1981) Emergency abdominal wall reconstruction with polypropylene mesh: short-term benefits versus long-term complications. Ann Surg 194(2):219–223PubMedPubMedCentralCrossRef

Moreno-Egea A, Aguayo-Albasini JL (2010) Historic analysis of complex incisional hernia: to an understanding of the double prosthetic repair technique. Cir Esp 88(5):292–298. doi:10.1016/j.ciresp.2010.05.002 PubMedCrossRef

Broker M, Verdaasdonk E, Karsten T (2011) Components separation technique combined with a double-mesh repair for large midline incisional hernia repair. World J Surg 35(11):2399–2402. doi:10.1007/s00268-011-1249-6 PubMedPubMedCentralCrossRef

Fei Y (2012) Compound repair of intraperitoneal onlay mesh associated with the sublay technique for giant lower ventral hernia. Ann Plast Surg 69(2):192–196. doi:10.1097/SAP.0b013e3182250dfb PubMedCrossRef

10.

Moreno-Egea A, Mengual-Ballester M, Cases-Baldo MJ, Aguayo-Albasini JL (2010) Repair of complex incisional hernias using double prosthetic repair: single-surgeon experience with 50 cases. Surgery 148(1):140–144. doi:10.1016/j.surg.2009.12.014 PubMedCrossRef

11.

Carbonell Tatay F, Bonafe Diana S, Garcia Pastor P, Gomez IGC, Baquero Valdelomar R (2009) New surgical technique in complex incisional hernias: component Separation Technique (CST) with prosthesis and new muscle insertions. Cir Esp 86(2):87–93. doi:10.1016/j.ciresp.2009.03.015 PubMedCrossRef

12.

Deerenberg EB, Timmermans L, Hogerzeil DP, Slieker JC, Eilers PH, Jeekel J, Lange JF (2015) A systematic review of the surgical treatment of large incisional hernia. Hernia J Hernias Abdom Wall Surg 19(1):89–101. doi:10.1007/s10029-014-1321-x CrossRef

13.

Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86(3):519–526PubMedCrossRef

14.

Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietanski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia J Hernias Abdom Wall Surg 13(4):407–414. doi:10.1007/s10029-009-0518-x CrossRef

15.

Celdran A, Frieyro O, de la Pinta JC, Souto JL, Esteban J, Rubio JM, Senaris JF (2004) The role of antibiotic prophylaxis on wound infection after mesh hernia repair under local anesthesia on an ambulatory basis. Hernia J Hernias Abdom Wall Surg 8(1):20–22. doi:10.1007/s10029-003-0164-7 CrossRef

16.

Celdran-Uriarte A, Fraile M, Garcia-Vasquez C, York E, Manso B, Granizo JJ (2011) A simplified incision of the external oblique aponeurosis during the components separation technique for the repair of large incisional hernias. Am J Surg 202(3):e31–e33. doi:10.1016/j.amjsurg.2010.08.039 PubMedCrossRef

17.

Celdran A, Garcia-Urena MA, Bazire P, Marijuan JL (1996) The use of omentum in mesh repair of ventral hernias. Am Surg 62(6):443–445PubMed

18.

Maas SM, van Engeland M, Leeksma NG, Bleichrodt RP (1999) A modification of the “components separation” technique for closure of abdominal wall defects in the presence of an enterostomy. J Am Coll Surg 189(1):138–140PubMedCrossRef

19.

Shestak KC, Edington HJ, Johnson RR (2000) The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg 105 (2):731–738; quiz 739

20.

Espinosa-de-Los-Monteros A, de la Torre JI, Ahumada LA, Person DW, Rosenberg LZ, Vasconez LO (2006) Reconstruction of the abdominal wall for incisional hernia repair. Am J Surg 191(2):173–177. doi:10.1016/j.amjsurg.2005.07.037 PubMedCrossRef

21.

de Vries Reilingh TS, van Goor H, Rosman C, Bemelmans MH, de Jong D, van Nieuwenhoven EJ, van Engeland MI, Bleichrodt RP (2003) “Components separation technique” for the repair of large abdominal wall hernias. J Am Coll Surg 196(1):32–37PubMedCrossRef

22.

Clarke JM (2010) Incisional hernia repair by fascial component separation: results in 128 cases and evolution of technique. Am J Surg 200(1):2–8. doi:10.1016/j.amjsurg.2009.07.029 PubMedCrossRef

23.

Bauer JJ, Harris MT, Gorfine SR, Kreel I (2002) Rives-Stoppa procedure for repair of large incisional hernias: experience with 57 patients. Hernia J Hernias Abdom Wall Surg 6(3):120–123. doi:10.1007/s10029-002-0071-3 CrossRef

24.

Heartsill L, Richards ML, Arfai N, Lee A, Bingener-Casey J, Schwesinger WH, Sirinek KR (2005) Open Rives-Stoppa ventral hernia repair made simple and successful but not for everyone. Hernia J Hernias Abdom Wall Surg 9(2):162–166. doi:10.1007/s10029-005-0319-9 CrossRef

25.

O’Halloran EB, Barwegen CJ, Dombrowski JM, Vandevender DK, Luchette FA (2014) Can’t have one without the other: component separation plus mesh for repairing difficult incisional hernias. Surgery 156(4):894–899. doi:10.1016/j.surg.2014.06.021 PubMedCrossRef

26.

Satterwhite TS, Miri S, Chung C, Spain D, Lorenz HP, Lee GK (2012) Outcomes of complex abdominal herniorrhaphy: experience with 106 cases. Ann Plast Surg 68(4):382–388. doi:10.1097/SAP.0b013e31823b68b1 PubMedCrossRef

27.

Askar OM (1984) Aponeurotic hernias. Recent observations upon paraumbilical and epigastric hernias. Surg Clin N Am 64(2):315–333PubMed

28.

Neidhardt JPH, Chevrel JP, Flament JB, Rives J (1998) Defects of the abdominal wall. In: Chevrel JP (ed) Hernias and surgery of the abdominal wall. Springer, Berlin, pp 111–169. doi:10.1007/978-3-642-48881-8_8 CrossRef

29.

DuBay DA, Choi W, Urbanchek MG, Wang X, Adamson B, Dennis RG, Kuzon WM Jr, Franz MG (2007) Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis. Ann Surg 245(1):140–146. doi:10.1097/01.sla.0000251267.11012.85 PubMedPubMedCentralCrossRef

30.

Culbertson EJ, Xing L, Wen Y, Franz MG (2013) Reversibility of abdominal wall atrophy and fibrosis after primary or mesh herniorrhaphy. Ann Surg 257(1):142–149. doi:10.1097/SLA.0b013e31825ffd02 PubMedPubMedCentralCrossRef

31.

Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558. doi:10.1016/j.surg.2010.01.008 PubMedCrossRef

32.

Barbosa MV, Nahas FX, de Oliveira Filho RS, Ayaviri NA, Novo NF, Ferreira LM (2010) A variation in the component separation technique that preserves linea semilunaris: a study in cadavers and a clinical case. J Plast Reconstr Aesthet Surg JPRAS 63(3):524–531. doi:10.1016/j.bjps.2008.12.008 PubMedCrossRef

33.

Iversen E, Lykke A, Hensler M, Jorgensen LN (2010) Abdominal wall hernia repair with a composite ePTFE/polypropylene mesh: clinical outcome and quality of life in 152 patients. Hernia J Hernias Abdom Wall Surg 14(6):555–560. doi:10.1007/s10029-010-0729-1 CrossRef

Title: A stepwise approach based on a rational use of components separation and double mesh prosthesis for incisional hernia repair
Authors: Á. Celdrán
M. J. Fraile
T. Georgiev-Hristov
S. González-Ayora
Publication date: 01-04-2016
Publisher: Springer Paris
Published in: Hernia / Issue 2/2016
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-015-1438-6

At a glance: The STEP trials

Springer Medicine

A stepwise approach based on a rational use of components separation and double mesh prosthesis for incisional hernia repair

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2016

Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care

Onlay parastomal hernia repair with cross-linked porcine dermal collagen biologic mesh: long-term results

Reply to comment to Long-term outcomes (>5 years follow-up) with porcine acellular dermal matrix (Permacol™) in incisional hernias at risk for infection: Negro P, D’Amore L, Ceci F, Gossetti F (DOI 10.1007/s10029-015-1406-1)

Enhanced recovery after giant ventral hernia repair

Diaphragmatic crural augmentation utilising cross-linked porcine dermal collagen biologic mesh (Permacol™) in the repair of large and complex para-oesophageal herniation: a retrospective cohort study