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

Archives of Surgery 2009 November
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.

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