David Foulad, MD, Brice Jabo, MD, MPH, Stephanie Keeth, MSN, Daniel Srikureja, MD, Keith Scharf, DO, FACS, Marcos Michelotti, MD, FACS, Esther Wu, MD. Loma Linda University Health, Division of General Surgery, Loma Linda CA
INTRODUCTION: Ventral hernia repairs using component separation techniques have gained momentum over the past decades due to their ability to cover large defects. An anterior approach where flaps are raised off the anterior rectus sheath with external oblique release (EOR) allows on-lay mesh re-enforcement. Alternatively, with the retrorectus repair (RRR), the rectus abdominis muscle is dissected from the underlying posterior rectus sheath with mesh placement in the retro-rectus space. The objective of the study is to evaluate differences in outcomes and complication rates between EOR and RRR approaches in abdominal hernia repair.
METHODS: A retrospective cohort study in a single tertiary institute between 2013 and 2015 was reviewed. Inclusion criteria consisted of ventral hernia repair as the primary surgery, and bilateral muscle flap advancement with complete fascial and skin closure. Patients who were hospitalized for trauma or had an open abdomen in the same hospital stay were excluded. Categorical variables were identified with data analyzed using Fisher’s exact test. Continuous variables between the two surgical techniques were evaluated using Wilcoxon test. Analysis was conducted using SAS software.
RESULTS: 103 patients were initially identified. Of those, 49 met inclusion criteria. 28 patients received EOR while 21 had RRR. Hernia defect size was significantly larger for the EOR as compared to the RRR (mean defect size area of 202cm2 vs 100cm2) and had an increased mean number of intra-operative drains used (2.7 vs 1.1). Accordingly, EOR group also had a significantly increased median operative time (234min vs 139min, P<0.001), and a trend in increased number of patients with prior ventral hernia surgeries (79% vs 52%, p=0.07). Differences in demographics and preoperative risk factors were not statistically significant. The EOR compared to RRR had a trend in increased rate of superficial surgical site infections (SSI) (32% vs 9.5%, p=0.09), deep SSI (14% vs 4.8%, p=0.38), need for IR drainage (18% vs 4.8%, p=0.22), and overall 90-day complication rate (50% vs 33%, p=0.38). The recurrence rate between the two methods was similar (11% vs 7.1%, p=0.999).
CONCLUSIONS: This study shows no statistical difference in outcomes noted between EOR and RRR, supportive of surgeon preference for surgical approach. The trend for increased SSI rate in EOR is likely secondary to larger hernia defects in this cohort, and large fasciocutaneous flaps created, resulting in increased potential space for seromas and need for prolonged drainage. Further analysis in the form of prospective randomization is warranted.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80505
Program Number: P056
Presentation Session: Poster (Non CME)
Presentation Type: Poster