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

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 reconstr...

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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
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Abstract	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.
AbstractList	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. 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. 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. 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. 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.INTRODUCTIONIndividuals 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.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.METHODSAdult 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.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.RESULTSTwelve 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.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.CONCLUSIONVentral hernia repair with TAR is feasible in patients with connective tissue disorder and can be a suitable alternative in patients with large complex hernias. IntroductionIndividuals 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.MethodsAdult 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.ResultsTwelve 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.ConclusionVentral hernia repair with TAR is feasible in patients with connective tissue disorder and can be a suitable alternative in patients with large complex hernias. 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.
Author	Fafaj, A. Maskal, S. M. Petro, C. C. Prabhu, A. S. Messer, N. Miller, B. T. Beffa, L. R. A. Krpata, D. M. Ellis, R. C. Phillips, S. E. Figueiredo, S. Rosen, M. J.
Author_xml	– sequence: 1 givenname: N. orcidid: 0000-0002-4686-9583 surname: Messer fullname: Messer, N. email: masrinir@gmail.com organization: Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Department of Surgery, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel-Aviv University – sequence: 2 givenname: A. S. surname: Prabhu fullname: Prabhu, A. S. organization: Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation – sequence: 3 givenname: B. T. surname: Miller fullname: Miller, B. T. organization: Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation – sequence: 4 givenname: D. M. surname: Krpata fullname: Krpata, D. M. organization: Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation – sequence: 5 givenname: L. R. A. surname: Beffa fullname: Beffa, L. R. A. organization: Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation – sequence: 6 givenname: S. E. surname: Phillips fullname: Phillips, S. E. organization: The Abdominal Core Health Quality Collaborative – sequence: 7 givenname: C. C. surname: Petro fullname: Petro, C. C. organization: Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation – sequence: 8 givenname: S. M. surname: Maskal fullname: Maskal, S. M. organization: Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation – sequence: 9 givenname: R. C. surname: Ellis fullname: Ellis, R. C. organization: Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation – sequence: 10 givenname: S. surname: Figueiredo fullname: Figueiredo, S. organization: Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation – sequence: 11 givenname: A. surname: Fafaj fullname: Fafaj, A. organization: Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation – sequence: 12 givenname: M. J. surname: Rosen fullname: Rosen, M. J. organization: Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation
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Keywords	Transversus abdominis release Connective tissue disorders Ventral hernia repair Marfan’s syndrome Surgical site occurrences Hernia recurrence
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Snippet	Introduction Individuals diagnosed with connective tissue disorders (CTD) are known to be predisposed to incisional hernia formation. However, there is a... Individuals diagnosed with connective tissue disorders (CTD) are known to be predisposed to incisional hernia formation. However, there is a scarcity of data... IntroductionIndividuals diagnosed with connective tissue disorders (CTD) are known to be predisposed to incisional hernia formation. However, there is a...
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SubjectTerms	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
Title	Outcomes of complex abdominal wall reconstruction in patients with connective tissue disorders: a single center experience
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