Abdominal wall reconstruction: lessons learned from 200 "components separation" procedures.

OBJECTIVES

To determine the efficacy and describe the evolution of the "components separation" technique for abdominal wall repair in 200 consecutive patients.

DESIGN

Retrospective medical record review.

SETTING

Northwestern Memorial Hospital, Chicago, Illinois.

PATIENTS: Two hundred consecutive patients who underwent ventral hernia repair using the components separation technique.

INTERVENTIONS: Biological and permanent meshes were used in select patients to augment the repair of the midline fascial closure but were not used as "bridging" materials.

MAIN OUTCOME MEASURES: Hernia recurrence rates and major and minor complication rates for the overall series and for the different techniques.

RESULTS

Primary components separation (n = 158) yielded a 22.8% recurrence rate. Closure of the midline tissues with augmentation of the repair using an acellular cadaveric dermis underlay (n = 18) had a 33.3% recurrence rate requiring a second operation, whereas intra-abdominal soft polypropylene mesh (n = 18) had 0% recurrence (P = .04). Elevated body mass index was a significant risk factor predicting hernia recurrence (P = .003). Contamination (P = .04) and enterocutaneous fistula (P = .02) at the time of surgery were associated with increased major complications, whereas body mass index (P = .01) and diabetes mellitus (P = .04) were associated with increased minor complications.

CONCLUSIONS

Large complex hernias can be reliably repaired using the components separation technique despite the presence of open wounds, the need for bowel surgery, and numerous comorbidities. The long-term strength of the hernia repair is not augmented by acellular cadaveric dermis but seems to be improved with soft polypropylene mesh.