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Hernia
Published in: Hernia 2/2015

01-04-2015 | Original Article

Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation

Authors: E. M. Pauli, J. Wang, C. C. Petro, R. M. Juza, Y. W. Novitsky, M. J. Rosen

Published in: Hernia | Issue 2/2015

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Abstract

Purpose

Anterior component separation (ACS) with external oblique release for ventral hernia repair has a recurrence rate up to 32 %. Hernia recurrence after prior ACS represents a complex surgical challenge. In this context, we report our experience utilizing posterior component separation with transversus abdominis muscle release (PCS/TAR) and retromuscular mesh reinforcement.

Methods

Patients with a history of recurrent hernia following ACS repaired with PCS/TAR were retrospectively identified from prospective databases collected at two large academic institutions. Patient demographics, hernia characteristics (using CT scan) and outcomes were evaluated.

Results

Twenty-nine patients with a history of ACS developed 22 (76 %) midline, 3 (10 %) lateral and 4 (14 %) concomitant recurrences. Contamination was present in 11 (38 %) of cases. All were repaired utilizing a PCS/TAR with retromuscular mesh placement (83 % synthetic, 17 % biologic) and fascial closure. Wound morbidity consisted of 13 (45 %) surgical site occurrences including 8 (28 %) surgical site infections. Five (17 %) patients required 90-day readmission, and two (7 %) were related to wound morbidity. One organ space infection with frank spillage of stool resulted in the only instance of mesh excision. This case also represents the only instance of recurrence (3 %) with a mean follow-up of 11 (range 3–36) months.

Conclusion

Patients with a history of an ACS who develop a recurrence represent a challenging clinical scenario with limited options for surgical repair. A PCS/TAR hernia repair achieves acceptable outcomes and may in fact be the best approach available.
Literature
1.
Poulose BK, Shelton J, Phillips S et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183CrossRefPubMed
2.
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):519–526CrossRefPubMed
3.
Hood K, Millikan K, Pittman T et al (2013) Abdominal wall reconstruction: a case series of ventral hernia repair using the component separation technique with biologic mesh. Am J Surg 205(3):322–327CrossRefPubMed
4.
Kanters AE, Krpata DM, Blatnik JA et al (2012) Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg 215(6):787–793CrossRefPubMed
5.
Ventral Hernia Working G, Breuing K, Butler CE et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558CrossRef
6.
Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20(5):271–274CrossRefPubMed
7.
Novitsky YW, Elliott 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(5):709–716CrossRefPubMed
8.
Pauli EM, Rosen MJ (2013) Open ventral hernia repair with component separation. Surg clinics North Am 93(5):1111–1133CrossRef
9.
Ko JH, Wang EC, Salvay DM et al (2009) Abdominal wall reconstruction: lessons learned from 200 “components separation” procedures. Arch Surg 144(11):1047–1055CrossRefPubMed
10.
Dumanian GA, Denham W (2003) Comparison of repair techniques for major incisional hernias. Am J Surg 185(1):61–65CrossRefPubMed
11.
Leppaniemi A, Tukiainen E (2013) Reconstruction of complex abdominal wall defects. Scand J Surg 102(1):14–19CrossRefPubMed
12.
Satterwhite TS, Miri S, Chung C et al (2012) Outcomes of complex abdominal herniorrhaphy: experience with 106 cases. Ann Plast Surg 68(4):382–388CrossRefPubMed
13.
Hicks CW, Krpata DM, Blatnik JA et al (2012) Long-term effect on donor sites after components separation: a radiographic analysis. Plast Reconstr Surg 130(2):354–359CrossRefPubMed
14.
Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ (2012) Posterior and open anterior components separations: a comparative analysis. Am J Surg 203(3):318–322CrossRefPubMed
15.
De Silva GS, Krpata DM, Hicks CW et al (2014) Comparative radiographic analysis of changes in the abdominal wall musculature morphology after open posterior component separation or bridging laparoscopic ventral hernia repair. J Am Coll Surg 218(3):353–357CrossRefPubMed
16.
den Hartog D, Eker HH, Tuinebreijer WE et al (2010) Isokinetic strength of the trunk flexor muscles after surgical repair for incisional hernia. Hernia 14(3):243–247CrossRef
17.
Hultman CS, Tong WM, Kittinger BJ et al (2011) Management of recurrent hernia after components separation: 10-year experience with abdominal wall reconstruction at an academic medical center. Ann Plast Surg 66(5):504–507CrossRefPubMed
18.
DiCocco JM, Magnotti LJ, Emmett KP et al (2010) Long-term follow-up of abdominal wall reconstruction after planned ventral hernia: a 15-year experience. J Am Coll Surg 210(5):686–695CrossRefPubMed
Metadata
Title
Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation
Authors
E. M. Pauli
J. Wang
C. C. Petro
R. M. Juza
Y. W. Novitsky
M. J. Rosen
Publication date
01-04-2015
Publisher
Springer Paris
Published in
Hernia / Issue 2/2015
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-014-1331-8

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