Components Separation for Abdominal Wall Reconstruction in the Recalcitrant, High-Comorbidity Patient: A Review of 311 Single-Surgeon Cases

被引:6
作者
Naran, Sanjay [1 ]
Shakir, Sameer [2 ]
Shestak, Kenneth C. [1 ]
Russavage, James M. [1 ]
Nguyen, Vu T. [1 ]
机构
[1] Univ Pittsburgh, Dept Plast Surg, 3550 Terrance St,Scaife Hall,Suite 6B, Pittsburgh, PA 15261 USA
[2] Univ Penn, Div Plast Surg, Philadelphia, PA 19104 USA
关键词
abdominal wall; component separation; hernia; separation of parts; VENTRAL HERNIA REPAIR; BIOLOGIC MESH; WOUND-INFECTION; SYNTHETIC MESH; DEFECTS; COMPLICATIONS; MANAGEMENT; RESECTION; CLOSURE; RISK;
D O I
10.1097/SAP.0000000000001275
中图分类号
R61 [外科手术学];
学科分类号
摘要
Purpose Components separation of the abdominal musculature remains a mainstay for closure of complicated midline and paramedian abdominal wall defects. The authors critically analyzed their experience with this technique to identify prognosticators affecting long-term clinical outcomes. Methods A retrospective review was performed of patients undergoing components separation by a single senior surgeon (J.M.R.) between 2000 and 2010. Numerous perioperative patient characteristics were collected and analyzed to determine their effects on long-term clinical outcomes. Multivariable logistic regression was used to predict hernia recurrence and other adverse clinical outcomes. Results A total of 311 patients were identified (male, 51.1%). Mean age was 53.1 14.0 years, preoperative body mass index was 33.1 +/- 8.2 kg/m(2), and defect width was 11.4 +/- 7.5 cm. Patients who had prior hernia repair were 97.4%, with 38.3% having prior mesh placement. Average follow-up was 2.9 +/- 2.4 years. Overall hernia recurrence rate was 18.3%. Postoperative complications included seroma (9.3%), superficial wound infection (9.0%), skin dehiscence (4.82%), hematoma (3.2%), deep vein thrombos or pulmonary emolbus (3.2%), and skin flap ischemia (1.0%). Respiratory comorbidity (odds ratio, [OR], 2.02; P < 0.029), prior failed mesh repair (OR, 1.86; P < 0.045), and occurrence of any postoperative complication (OR, 2.02; P < 0.034) significantly increased the risk of eventual hernia recurrence. Preoperative body mass index was not associated with hernia recurrence (P < 0.351) or increased incidence of any aforementioned postoperative complications. Conclusions This study provides a comprehensive review of one of the largest single-surgeon experiences using components separation to date. Patients with respiratory comorbidities, prior failed mesh repair, and the occurrence of any postoperative complication are at significantly increased risk for hernia recurrence.
引用
收藏
页码:262 / 267
页数:6
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