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Open Access 01-12-2021 | Incisional Hernia | Original Article

Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

Authors: J. A. Pereira-Rodriguez, A. Bravo-Salva, B. Montcusí-Ventura, P. Hernández-Granados, V. Rodrigues-Gonçalves, M. López-Cano, the EVEREG Registry Members

Published in: Hernia | Issue 6/2021

Abstract

Aim

To analyze the outcomes of component separation techniques (CST) to treat incisional hernias (IH) in a large multicenter cohort of patients.

Methods

All IH repair using CST, registered in EVEREG from July 2012 to December 2019, were included. Data on the pre-operative patient characteristics and comorbidities, IH characteristics, surgical technique, complications, and recurrence were collected. Outcomes between anterior (ACS) and posterior component separation (PCS) techniques were compared. Risk factors for complications and recurrences were analyzed.

Results

During the study period, 1536 patients underwent CST (45.5% females) with a median age of 64.0 years and median body mass index (BMI) of 29.7 kg/m². ACS was the most common technique (77.7%). Overall complications were frequent in both ACS and PCS techniques (36.5%), with a higher frequency of wound infection (10.6% vs. 7.0%; P = 0.05) and skin necrosis (4.4% vs. 0.1%; P < 0.0001) with the ACS technique. Main factors leading to major complications were mesh explant (OR 1.72; P = 0.001), previous repair (OR 0.75; P = 0.038), morbid obesity (OR 0.67; P = 0.015), ASA grade (OR 0.62; P < 0.0001), COPD (OR 0.52; P < 0.0001), and longitudinal diameter larger than 10 cm (OR 0.58; P = 0.001). After a minimum follow-up of 6 months (median 15 months; N = 590), 59 (10.0%) recurrences were diagnosed. Operations performed in a non-specialized unit were significantly associated with recurrences (HR 4.903, CI 1.64–14.65; P = 0.004).

Conclusion

CST is a complex procedure with a high rate of complications. Both ACS and PCS techniques have similar complication and recurrence rates. Operations performed in a specialized unit have better outcomes.

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 19:89–101CrossRef

Hoffmann H, Köckerling F, Adolf D, Mayer F, Weyhe D, Reinpold W, Fortelny R, Kirchhoff P (2021) Analysis of 4,015 recurrent incisional hernia repairs from the Herniamed registry: risk factors and outcomes. Hernia 25:61–75CrossRef

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

Novitsky YW, Elliot HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204:709–716CrossRef

Razavi SA, Desai KA, Thompson PW, Hart AM, Losken A (2018) The impact of mesh reinforcement with components separation for abdominal wall reconstruction. Am Surg 84:959–962CrossRef

Kokotovic D, Bisgaard T, Helgstrand F (2016) Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 316:1575–1582CrossRef

Sandvall BK, Suver DW, Said HK, Mathes DW, Neligan PC, Dellinger EP, Louie O (2016) Comparison of synthetic and biologic mesh in ventral hernia repair using components separation technique. Ann Plast Surg 76:674–679CrossRef

Aliotta RE, Gatherwright J, Krpata D, Rosenblatt S, Rosen M, Gurunluoglu R (2019) Complex abdominal wall reconstruction, harnessing the power of a specialized multidisciplinary team to improve pain and quality of life. Hernia 23:205–215CrossRef

Blair LJ, Cox TC, Huntington CR, Groene SA, Prasad T, Lincourt AE, Kercher KW, Heniford BT, Augenstein VA (2017) The effect of component separation technique on quality of life (QOL) and surgical outcomes in complex open ventral hernia repair (OVHR). Surg Endosc 31:3539–3546CrossRef

10.

Naran S, Shakir S, Shestak KC, Russavage JM, Nguyen VT (2018) Components separation for abdominal wall reconstruction in the recalcitrant, high-comorbidity patient: a review of 311 single-surgeon cases (2018). Ann Plast Surg 80:262–267CrossRef

11.

Pereira JA, López-Cano M, Hernández-Granados P, Feliu X, en representación del grupo EVEREG (2016) Initial results of the national registry of incisional Hernia. Cir Esp 94:595–602CrossRef

12.

Pereira JA, Montcusí B, López-Cano M, Hernández-Granados P, Fresno de Prado L, Miembros del registro EVEREG (2018) Risk factors for bad results in the incisional hernia repair. Lessons learned from the National Registry of Incisional Hernia (EVEREG). Cir Esp 96:436–442CrossRef

13.

Pereira JA, Bravo-Salva A, Montcusí B, Pérez-Farre S, Fresno de Prado L, López-Cano M (2019) Incisional hernia recurrence after open elective repair: expertise in abdominal wall surgery matters. BMC Surg 19:103CrossRef

14.

Obesity: preventing and managing the global epidemic. Report of a WHO consultation (2000) World Health Organ. Tech Rep Ser 894:1–253

15.

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, Smietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414CrossRef

16.

Slater NJ, Montgomery A, Berrevoet F, Carbonell AM, Chang A, Franklin M, Kercher KW, Lammers BJ, Parra-Davilla E, Roll S, Towfigh S, van Geffen E, Conze J, van Goor H (2014) Criteria for definition of a complex abdominal wall hernia. Hernia 18:7–17CrossRef

17.

Ibarra-Hurtado TR, Nuño-Guzmán CM, Echegaray-Herrar JE, Robles-Vélez E, González-Jaime JJ (2009) Use of botulinum toxin type A before abdominal wall hernia reconstruction. World J Surg 33:2553–2556CrossRef

18.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef

19.

Desai NK, Leitman IM, Mills C, Lavarias V, Lucido DL, Karpeh MS (2016) Open repair of large abdominal wall hernias with and without components separation. An analysis from the ACS-NSQIP database. Ann Med Surg 7:14–19CrossRef

20.

Ghazi B, Deigni O, Yezhelyev M, Losken A (2011) Current options in the management of complex abdominal wall defects. Ann Plast Surg 66:488–492CrossRef

21.

Kaoutzanis C, Leichtle SW, Mouawad NJ, Welch KB, Lampman RM, Wahl WL, Cleary RK (2015) Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair. Hernia 19:113–123CrossRef

22.

Owei L, Swendiman RA, Kelz RR, Dempsey DT, Dumon KR (2017) Impact of body mass index on open ventral hernia repair: a retrospective review. Surgery 162:1320–1329CrossRef

23.

Helgstrand F, Rosenberg J, Kehlet H, Jorgensen LN, Bisgaard T (2013) Nationwide prospective study of outcomes after elective incisional hernia repair. J Am Coll Surg 216:217–228CrossRef

24.

Martínez-Serrano MA, Pereira JA, Sancho JJ, López-Cano M, Bombuy E, Hidalgo J, the Study Group of Abdominal Hernia Surgery of the Catalan Society of Surgery (2010) Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement. Langenbecks Arch Surg 395:551–556CrossRef

25.

Torregrosa-Gallud A, Sancho Muriel J, Bueno-Lledó J, García Pastor J, Iserte-Hernandez J, Bonafé-Diana S, Carreño-Sáenz O, Carbonell-Tatay F (2017) Modified components separation technique: experience treating large, complex ventral hernias at a University Hospital. Hernia 21:601–608CrossRef

26.

Nockolds CL, Hodde JP, Rooney PS (2014) Abdominal wall reconstruction with components separation and mesh reinforcement in complex hernia repair. BMC Surg 14:25CrossRef

27.

Maloney SR, Schlosser KA, Prasad T, Kasten KR, Gersin KS, Colavita PD, Kercher KW, Augenstein VA, Heniford BT (2019) Twelve years of component separation technique in abdominal wall reconstruction. Surgery 166:435–444CrossRef

28.

Docimo S Jr, Bates A, Alteri M, Talamini M, Pryor A, Spaniolas K (2020) Evaluation of the use of component separation in elderly patients: results of a large cohort study with 30-day follow-up. Hernia 24:503–507CrossRef

29.

Israelsson LA, Smedberg S, Montgomery A, Nordin P, Spangen L (2006) Incisional hernia repair in Sweden 2002. Hernia 10:258–261CrossRef

30.

Helgstrand F, Rosenberg J, Bay-Nielsen M, Friis-Andersen H, Wara P, Jorgensen LN, Kehlet H, Bisgaard T (2010) Establishment and initial experiences from the Danish ventral hernia database. Hernia 14:131–135CrossRef

31.

Bisgaard T, Kehlet H, Bay-Nielsen MB, Iversen MG, Wara P, Rosenberg J, Friis-Andersen HF, Jorgensen LN (2009) Nationwide study of early outcomes after incisional hernia repair. Br J Surg 96:1452–1457CrossRef

32.

Schwab R, Dietz UA, Menzel S, Wiegering A (2018) Pitfalls in interpretation of large registry data on hernia repair. Hernia 22(6):947–950. https://doi.org/10.1007/s10029-018-1837-6CrossRefPubMed

33.

Balla A, Alarcón I, Morales-Conde S (2020) Minimally invasive component separation technique for large ventral hernia: which is the best choice? A systematic literature review. Surg Endosc 34(1):14–30CrossRef

Title: Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)
Authors: J. A. Pereira-Rodriguez
A. Bravo-Salva
B. Montcusí-Ventura
P. Hernández-Granados
V. Rodrigues-Gonçalves
M. López-Cano
the EVEREG Registry Members
Publication date: 01-12-2021
Publisher: Springer Paris
Keyword: Incisional Hernia
Published in: Hernia / Issue 6/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-021-02449-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

Abstract

Aim

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aim

Methods

Results

Conclusion

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