Long-Term Follow-Up of Abdominal Wall Reconstruction after Planned Ventral Hernia: A 15-Year Experience

BACKGROUND: Although damage control strategies and the open abdomen have improved survival, they present their own unique set of challenges in caring for the multiply injured trauma patient. We previously reported the technique of staged abdominal wall closure for the management of the open abdomen. The purpose of this study was to evaluate the efficacy of various techniques of abdominal wall reconstruction (final stage of management) on long-term outcomes after planned ventral hernia, and to better define risk factors for recurrence. STUDY DESIGN: Patients undergoing abdominal wall reconstruction over a 15-year period were identified and stratified by gender, age, severity of shock, injury severity, and method of repair: secondary fascial closure +/- prosthetic, standard components separation (SCS) +/- prosthetic and modified components separation (MCS) +/- prosthetic. Long-term outcomes (recurrence) were determined using hospital records, telephone interview, and physical examination. Multivariable logistic regression analysis was performed to determine independent predictors of recurrence. RESULTS: One hundred fifty-two patients were identified. Fourteen (9%) patients underwent secondary fascial closure +/- prosthetic, 47 (31%) underwent SCS +/- prosthetic, and 91 (60%) underwent MCS +/- prosthetic. Long-term follow-up (up to 14.6 years, mean 5.3 years) was obtained in 114 (75%) patients. Sixteen patients (14%) had a recurrence. Prosthetic use increased recurrence 4-fold. There were 2 known recurrences (5%) in patients with MCS without prosthetic. Logistic regression identified both female gender and body mass index as independent predictors of recurrence. CONCLUSIONS: The MCS technique is the procedure of choice for repair of giant abdominal wall defects. This approach can avoid the need for prosthetics. In fact, MCS without prosthetic resulted in an acceptably low hernia recurrence rate (5%). (J Am Coll Surg 2010;210:686-698. (C) 2010 by the American College of Surgeons)