Outcomes of complex abdominal wall reconstruction in patients with connective tissue disorders: a single center experience

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 28; no. 3; pp. 831 - 837
• Main Authors: Messer, N., Prabhu, A. S., Miller, B. T., Krpata, D. M., Beffa, L. R. A., Phillips, S. E., Petro, C. C., Maskal, S. M., Ellis, R. C., Figueiredo, S., Fafaj, A., Rosen, M. J.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-06-2024; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Abdominal wall; Complex Incisional Hernia; Connective tissue; Connective tissue diseases; Hernia; Hernias; Medicine; Medicine & Public Health; Morbidity; Original Article; Patients; Quality of life; Scleroderma; Systemic lupus erythematosus; Transversus abdominis release; Connective tissue disorders; Ventral hernia repair; Marfan’s syndrome; Surgical site occurrences; Hernia recurrence
• ISSN: 1248-9204; 1265-4906; 1248-9204
• DOI: 10.1007/s10029-023-02957-y

Introduction
Individuals diagnosed with connective tissue disorders (CTD) are known to be predisposed to incisional hernia formation. However, there is a scarcity of data on outcomes for these patients undergoing hernia repair. We sought to describe our outcomes in performing abdominal wall reconstructions in these complex patients.
Methods
Adult patients with CTD undergoing open, elective, posterior component separation with permanent synthetic mesh at our institution from January 2018 to October 2022 were queried from a prospectively collected database in the Abdominal Core Health Quality Collaborative. We evaluated 30-day wound morbidity, perioperative complications, long-term hernia recurrence, and patient-reported quality of life.
Results
Twelve patients were identified. Connective tissue disorders included Marfan’s n = 7 (58.3%), Loeys-Dietz syndrome n = 2 (16.7%), Systemic Lupus Erythematosus n = 2 (16.7%), and Scleroderma n = 1 (8.3%). Prior incisions included three midline laparotomies and nine thoracoabdominal, mean hernia width measured 14 cm, and 9 were recurrent hernias. Surgical site occurrences (SSOs) were observed in 25% of cases, and 16.7% necessitated procedural intervention. All twelve patients were available for long-term follow-up, with a mean of 34 (12–62) months. There were no instances of reoperation or mesh excision related to the TAR procedure. One patient developed a recurrence after having his mesh violated for repair of a new visceral aneurysm. Mean HerQLes scores at 1 year were 70 and 89 at ≥ 2 years; Mean scaled PROMIS scores were 30.7 at 1 year and 36.3 at ≥ 2 years.
Conclusion
Ventral hernia repair with TAR is feasible in patients with connective tissue disorder and can be a suitable alternative in patients with large complex hernias.