Abdominal wall reconstruction with components separation and mesh reinforcement in complex hernia repair

BMC Surgery

Paul S Rooney²  Jason P Hodde¹  Claire L Nockolds² 

[1]Cook Biotech Incorporated, 1425 Innovation Place, West Lafayette, IN 47906, USA

[2]Royal Liverpool Hospital, Prescot Street, Liverpool, Merseyside, L7 8XP, UK

关键词: Reinforcement;    Mesh;    Biologic graft;    Components separation;    Infection;    Contamination;    Hernia;   

Others  :  866847
DOI  :  10.1186/1471-2482-14-25

 received in 2013-10-09, accepted in 2014-04-01,  发布年份 2014

【 摘 要 】

Background

Abdominal closure in the presence of enterocutaneous fistula, stoma or infection can be challenging. A single-surgeon’s experience of performing components separation abdominal reconstruction and reinforcement with mesh in the difficult abdomen is presented.

Methods

Medical records from patients undergoing components separation and reinforcement with hernia mesh at Royal Liverpool Hospital from 2009 to 2012 were reviewed. Patients were classified by the Ventral Hernia Working Group (VHWG) grading system. Co-morbidities, previous surgeries, specific type of reconstruction technique, discharge date, complications and hernia recurrence were recorded.

Results

Twenty-three patients’ (15 males, 8 females) notes were reviewed. Median age was 57 years (range 20-76 years). Median follow-up at the time of review was 17 months (range 2-48 months). There were 13 grade III hernias and 10 grade IV hernias identified. Synthetic mesh was placed to reinforce the abdomen in 6 patients, cross-linked porcine dermis was used in 3, and a Biodesign^® Hernia Graft was placed in 14. Complications included wound infection (13%), superficial wound dehiscence (22%), seroma formation (22%) and stoma complications (9%). To date, hernias have recurred in 3 patients (13%).

Conclusions

Components separation and reinforcement with biological mesh is a successful technique in the grade III and IV abdomen with acceptable rate of recurrence and complications.

【 授权许可】

   
2014 Nockolds et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D, Ventral Hernia Working Group: ncisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 2010, 148:544-558.
• [2]Houck JP, Rypins EB, Sarfeh IJ, Juler GL, Shimoda KJ: Repair of incisional hernia. Surg Gynecol Obstet 1989, 169:397-399.
• [3]Iqbal CW, Pham TH, Joseph A, Mai J, Thompson GB, Sarr MG: Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg 2007, 31:2398-2404.
• [4]Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A: Classification of primary and incisional abdominal wall hernias. Hernia 2009, 13:407-414.
• [5]Arnaud J, Tuech J, Pessaux P, Hadchity Y: Surgical treatment of postoperative incisional hernias by intraperitoneal insertion of Dacron mesh and an aponeurotic graft. Arch Surg 1999, 134:1260-1262.
• [6]Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J: Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004, 240:578-583. discussion 583-585
• [7]Hughes LE: Incisional hernia. Asian J Surg 1990, 13:69.
• [8]Ramirez OM, Ruas E, Dellon AL: “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 1990, 86:519-526.
• [9]Itani KMF, Rosen M, Vargo D, Awad SS, DeNoto G III, Butler CE: Prospective study of single-stage repair of contaminated hernias using a biological porcine tissue matrix: The RICH Study. Surgery 2012, 152:498-505.
• [10]de Vries Reilingh TS, van Geldere D, Langenhorst B, de Jong D, van der Wilt GJ, van Goor H, Bleichrodt RP: Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques. Hernia 2004, 8:56-59.
• [11]Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J: A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 2000, 343:392-398.
• [12]Rives J, Lardennois B, Pire JC, Hibon J: Large incisional hernias. The importance of flail abdomen and of subsequent respiratory disorders. Chirurgie 1973, 99:547-563.
• [13]Chevrel JP: The treatment of large midline incisional hernias by “overcoat” plasty and prosthesis (author’s transl). Nouv Presse Med 1979, 8:695-696.
• [14]Sailes FC, Walls J, Guelig D, Mirzabeigi M, Long WD, Crawford A, Moore JH Jr, Copit SE, Tuma GA, Fox J: Synthetic and biological mesh in component separation: A 10-year single institution review. Ann Plast Surg 2010, 64:696-698.
• [15]Kapiris SA, Brough WA, Royston CM, O’Boyle C, Sedman PC: Laparoscopic transabdominal preperitoneal (TAPP) hernia repair. A 7-year two-center experience in 3017 patients. Surg Endosc 2001, 15:972-975.
• [16]Bingener J, Kazantsev GB, Chopra S, Schwesinger WH: Adhesion formation after laparoscopic ventral incisional hernia repair with polypropylene mesh: a study using abdominal ultrasound. JSLS 2004, 8:127-131.
• [17]Krpata DM, Stein SL, Eston M, Ermlich B, Blatnik JA, Novitsky YW, Rosen MJ: Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown. Am J Surg 2013, 205:354-358.