David J Ryan, MD, Monica Gustafson, MD, Pellini Brian, MD, Randall Kimball, Ibrahim M Daoud. St. Francis Hospital
The repair of large incisional hernias is a daunting problem for a surgeon to face. Component separation with placement of a retro-rectus underlay mesh has been an important method allowing one to close the fascia tension free while also having underlay mesh reinforcement. This study reviews the data of one surgeon at a single institution from 2010 to 2014. The purpose of this review is to assess the successes and failures of an anterior component separation over a 4 year period.
Methods and Procedures:
We present a review of 86 case of anterior component separation from February 2010 to July 2014. Laparoscopic and open component separations were complete by a single surgeon at a single institution over this time period. Data was reviewed specifically identifying cases of infection, seroma formation and recurrence. Complications were identified in the immediate post operative inpatient period and in the follow up outpatient period.
Eighty six patients were included in the study. Seventy seven (90%) underwent a laparoscopic component separation, six (7%) had an open component separation, and 3 (3%) had a combined approach. The median preoperative defect was 10.5cm (6-29cm). The median age of the patients was 57 (16-83) years. Three (3%) recurrences occurred and all were within a year of the initial hernia repair. 1 patient eviscerated in the immediate post operative period. Ten (11%) patients had persistent drainage or seromas. Ten (11%) patients had evidence of cellulitis post operatively while 2 patients developed post operative abdominal wall abscesses requiring drainage and 2 patients developed abdominal skin necrosis requiring debridement.
Review of this data demonstrates that over a follow up period of up to four years, anterior component separation is an effective repair of a large incisional hernia. The majority of the post operative complications can be managed simply with antibiotics or observation with a small percentage requiring intervention. With a 3.5% recurrence rate over a follow up range from three months to four years this procedure clearly provides an adequate repair of complicated hernias. The infections wound complications are of a similar rate as one would expect form similar laparotomy procedures. The dead-space created during the separation does subject one to post operative seromas which occurred in 11% of cases despite drainage of the dead-space at the time of surgery.