Modified components separation technique: experience treating large, complex ventral hernias at a University Hospital

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 21; no. 4; pp. 601 - 608
• Main Authors: Torregrosa-Gallud, A., Sancho Muriel, J., Bueno-Lledó, J., García Pastor, P., Iserte-Hernandez, J., Bonafé-Diana, S., Carreño-Sáenz, O., Carbonell-Tatay, F.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-08-2017; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Abdominal wall; Adult; Aged; Botulinum toxin; Classification; Compartment syndrome; Defects; Female; Fistulae; Hematoma; Hernia; Hernia, Ventral - surgery; Hernias; Herniorrhaphy - adverse effects; Herniorrhaphy - methods; Herniorrhaphy - statistics & numerical data; Hospitals, University - statistics & numerical data; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Original Article; Population studies; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Recurrence; Seroma - epidemiology; Seroma - etiology; Small intestine; Spain - epidemiology; Surgical Mesh; Component separation technique; Complex hernia; Mesh; Large ventral hernia; Ventral hernia; Incisional hernia
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-017-1619-6

Background
An increasing number of patients have large or complex abdominal wall defects. Component separation technique (CST) is a very effective method for reconstructing complex midline abdominal wall defects in a manner that restores innervated muscle function without excessive tension. Our goal is to show our results by a modified CST for treating large ventral hernias.
Materials and methods
A total of 351 patients with complex ventral hernias have been treated over a 10-year period. Pre- and postoperative CT scans were performed in all patients. All ventral hernias were W3, according to the EHS classification 1. We analyzed demographic variables, co-morbidities, hernia characteristics, operative, and postoperative variables.
Results
One hundred and seventy patients (48.4%) were men; the average age of the study population was 51.6 ± 23.2 years with an average BMI of 32.3 ± 1.3. The hernia was located in the midline in 321 cases (91.5%) versus the flank in 30 (8.5%). In 45 patients, preoperative botulinum toxin (BT) and progressive pneumoperitoneum (PPP) were needed due to giant hernia defects when the VIH/VAC ratio was >20%. Postoperative complications related to the surgical site were seroma (35.1%), hematoma (9.1%), infection (7.2%), and wound necrosis (8.8%). Complications related to the repair were evisceration in 3 patients (1.1%), small bowel fistula in 4 patients (1.5%), 11 cases of mesh infection (2.9%), and abdominal compartment syndrome (ACS) in 2 patients. There were 29 hernia recurrences (8.2%) with a mean follow-up of 31.6 ± 8.1 months.
Conclusion
The modified CST is an effective strategy for managing complex ventral hernias that enables primary fascial closure with low rates of morbidity and hernia recurrence.