The Effect of Component Separation Technique on Quality of Life (QOL) and Surgical Outcomes in Complex Open Ventral Hernia Repair (OVHR)

Laurel J Blair, MD, Tiffany C Cox, MD, Ciara R Huntington, MD, Steven A Groene, MD, Tanushree Prasad, MA, Amy E Lincourt, PhD, MBA, Kent W Kercher, MD, FACS, B. Todd Heniford, MD, FACS, Vedra A Augenstein, MD, FACS. Carolinas Medical Center

Introduction: The type of component separation may affect outcomes following OVHR.  In this study, outcomes including QOL of patients undergoing OVHR were evaluated based on the utilization of transversus abdominis release (TAR), posterior rectus sheath release (PRSR) alone, or in combination with external oblique release (EOR+PRSR).

Methods: A prospective, single institution study following open ventral hernia repair involving component separation was performed from May 2005 to April 2015. Self-reported QOL outcomes were obtained preoperatively and at 1, 6, and 12 months postoperatively using the Carolinas Comfort Scale (CCS). A CCS of 2 (mild but bothersome discomfort) or greater was considered symptomatic. Comorbidities, complications, outcomes, and CCS scores were reviewed.   Univariate group comparisons were performed using chi-square and Wilcoxon two-sample tests with statistical significance set at p<0.05. 

Results: During the study period, 298 OVHRs with CST met inclusion criteria.  Demographics included: average age-56.9 ±11.8 years, BMI-33.7±7.5 kgm2, 52% female, 67% at least one prior hernia repair, and average defect size-279.1±224.7 cm2.  Preoperative discomfort (82% vs 74% vs 78%,p=0.73) and movement limitation (94% vs 70% vs 78%,p=0.09) in TAR, PRSR and EOR+PRSR respectively were similar. Average follow up was >15 months.  At 1, 6, and 12 months post-operatively, there was no difference in reported CCS pain scores, movement limitation, or mesh sensation among the groups (p>0.05).  Comparing OVHR patients outcomes by CST type, TAR was associated with decreased wound infections compared to others (3.2% vs. 16.5% vs. 19.1% ,p<0.05) however, recurrence rates were similar (0% vs. 1.7% vs. 7.1%, p>0.05).   Eighty percent of patients who recurred had been repaired with a biologic mesh secondary to contaminated field during hernia repair.   The other two recurrences were one which occurred superior to the mesh and one who developed a wound infection postoperatively.  Mesh infection rates were low (0% vs. 1.9% vs. 3.4%, p>0.05) and were statistically equivalent among all three techniques.

Conclusion: While QOL is not impacted by type of component separation on short or long-term follow up, the TAR may provide benefits such as decreased wound infection rates.

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