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Hernia
Published in: Hernia 1/2013

01-02-2013 | Original Article

Components separation technique utilizing an intraperitoneal biologic and an onlay lightweight polypropylene mesh: “a sandwich technique”

Authors: L. M. Morris, K. A. LeBlanc

Published in: Hernia | Issue 1/2013

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Abstract

Purpose

Reconstruction of large, complex abdominal wall hernias is an ongoing challenge. Primary closure of such hernias is often not possible. The components separation technique (CST) is a practical option, however, recurrence rates remain unacceptably high. In an attempt to reduce recurrences, we added a biologic underlay mesh and a lightweight polypropylene onlay mesh to the traditional CST.

Methods

Patients with a large hernia defect with or without multiple recurrences were selected to undergo a CST augmented with an acellular porcine dermal collagen mesh underlay. Following midline abdominal closure, a lightweight, large-pore polypropylene onlay mesh was fixed to the abdominal fascia. The skin and subcutaneous layers were closed over two sump drains and two closed suction drains.

Results

Fifty-one patients underwent a mesh-reinforced CST from May 2006 to June 2010. The study population averaged 57.9 ± 1.5 years of age with 24 males and 27 females, BMI of 34.3 ± 0.9 kg/m2, ASA score of 2.62 ± 0.08, 29 % were smokers, 29 % were diabetic, and 69 % had at least one previous abdominal wall hernia repair. Operative time averaged 196.5 ± 7.2 min with a blood loss of 318 ± 24 mL, and average hernia defect size of 301 ± 31 cm2. Length of follow-up averaged 20.6 ± 2.1 months; surgical site occurrences were identified in 39 %, most commonly from skin necrosis. Hernia recurrence rate was 3.9 %.

Conclusions

Repair of large, complex abdominal wall hernias by CST augmented with a biologic underlay mesh and a lightweight polypropylene onlay mesh results in lower recurrence rates compared to historical reports of CST alone.
Literature
1.
Kim H, Bruen K, Vargo D (2006) Acellular dermal matrix in the management of high-risk abdominal wall defects. Am J Surg 192(6):705–709PubMedCrossRef
2.
3.
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
4.
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
5.
de Vries Reilingh TS, van Goor H, Charbon JA, Rosman C, Hesselink EJ, van der Wilt GJ, Bleichrodt RP (2007) Repair of giant midline abdominal wall hernias: “components separation technique” versus prosthetic repair: interim analysis of a randomized controlled trial. World J Surg 31(4):756–763PubMedCrossRef
6.
Nasajpour H, LeBlanc KA, Steele MH (2011) Complex hernia repair using component separation technique paired with intraperitoneal acellular porcine dermis and synthetic mesh overlay. Ann Plast Surg 66(3):280–284PubMedCrossRef
7.
McAdory RS, Cobb WS, Carbonell AM (2009) Progressive preoperative pneumoperitoneum for hernias with loss of domain. Am Surg 75(6):504–508; discussion 508–509
8.
Sukkar SM, Dumanian GA, Szczerba SM, Tellez MG (2001) Challenging abdominal wall defects. Am J Surg 181(2):115–121PubMedCrossRef
9.
Ko JH, Salvay DM, Paul BC, Wang EC, Dumanian GA (2009) Soft polypropylene mesh, but not cadaveric dermis, significantly improves outcomes in midline hernia repairs using the components separation technique. Plast Reconstr Surg 124(3):836–847PubMedCrossRef
10.
Saettele TM, Bachman SL, Costello CR, Grant SA, Cleveland DS, Loy TS, Kolder DG, Ramshaw BJ (2007) Use of porcine dermal collagen as a prosthetic mesh in a contaminated field for ventral hernia repair: a case report. Hernia J Hernias Abdom Wall Surg 11(3):279–285CrossRef
11.
Franklin ME Jr, Gonzalez JJ Jr, Glass JL (2004) Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2-year follow-up. Hernia J Hernias Abdom Wall Surg 8(3):186–189
12.
van der kolk BM, de Vries Reilingh TS, Buyne O, Bleichrodt RP (2010) Components separation technique: pros and cons. In: Schumpelick V, Fitzgibbons R (eds) Hernia repair sequelae. Springer, Berlin, pp 143–151
13.
Welty G, Klinge U, Klosterhalfen B, Kasperk R, Schumpelick V (2001) Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 5(3):142–147PubMedCrossRef
14.
DiCocco JM, Magnotti LJ, Emmett KP, Zarzaur BL, Croce MA, Sharpe JP, Shahan CP, Jiao H, Goldberg SP, Fabian TC (2010) Long-term follow-up of abdominal wall reconstruction after planned ventral hernia: a 15-year experience. J Am Coll Surg 210(5):686–695, 695–688
15.
Harth KC, Rosen MJ (2010) Endoscopic versus open component separation in complex abdominal wall reconstruction. Am J Surg 199(3):342–346; discussion 346–347
16.
Saulis AS, Dumanian GA (2002) Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs. Plastic Reconstr Surg 109(7):2275–2280; discussion 2281–2272
17.
Rosen MJ, Williams C, Jin J, McGee MF, Schomisch S, Marks J, Ponsky J (2007) Laparoscopic versus open-component separation: a comparative analysis in a porcine model. Am J Surg 194(3):385–389PubMedCrossRef
18.
Agnew SP, Small W Jr, Wang E, Smith LJ, Hadad I, Dumanian GA (2010) Prospective measurements of intra-abdominal volume and pulmonary function after repair of massive ventral hernias with the components separation technique. Ann Surg 251(5):981–988PubMedCrossRef
Metadata
Title
Components separation technique utilizing an intraperitoneal biologic and an onlay lightweight polypropylene mesh: “a sandwich technique”
Authors
L. M. Morris
K. A. LeBlanc
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Hernia / Issue 1/2013
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-012-0949-7

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