Components Separation Technique Associated to a "Sandwich" Procedure in the Treatment of Large and Complex Incisional Hernias and Abdominal Wall Defects. A 30-Case Series

Martín Cartes JA, Tamayo-López MJ and Bustos Jiménez M

Department of Surgery, Hospital Universitario Virgen del Rocio, Spain

^*Correspondance to: Juan A. Martin-Cartes 

 PDF  Full Text DOI: 10.25107/2474-1647.1292

Abstract

Aim: Reconstruction of large, complex abdominal wall hernias is an interesting challenge. Primary closure of those hernias is often not possible. There is little agreement about the most appropriate technique or prosthetic to repair these defects, in spite the fact of the prevalence of ventral hernias. Sometimes despite being contaminated surgical fields, we are often faced to reinforce with bioprosthetic meshes. The components separation technique (CST) is a practical option; however, recurrence rates remain unacceptably high. In an attempt to reduce recurrences, we frequently added a biologic underlay mesh and a lightweight polypropylene only mesh to the traditional components separation technique. Our objective was to determine biologic mesh practice patterns of reconstructive surgeons with regard to indications, most appropriate technique, election of prosthetics, and experience with complications in order to work those large and complex hernias out.Methods: 30 consecutive patients who underwent abdominal wall reconstruction by means of components separations associated with non cross-linked porcine dermal scaffolds (NCPDS) or synthetic tissue scaffolds (STS) reinforcement between October 2009 and December 2011 were retrospectively reviewed. Analysis of demographics, indications for NCPDS or STS placement, surgical technique, complications, and follow-up data was performed. They underwent a “sandwich” procedure with a biologic underlay mesh and a lightweight polypropylene only mesh added to the traditional components separation technique, we chose NCPDS or STC underlay mesh according to the fact of the presence or absence of a contaminated field.Results: A “sandwich” procedure was used for abdominal wall repair in 30 patients. In all of them, NCPDS or STC was positioned using an intraperitoneal technique associated to a lightweight polypropylene only mesh and the components separation technique. At a mean follow-up time of 30.1 months, most patients had successful outcomes. Complications included seroma, recurrence, and infection. One of our patients died from multiorgan failure unrelated to hernia repair.Conclusion: This study shows that complex abdominal wall defects can be successfully reconstructed using a “sandwich” procedure with a low rate of recurrence and complications. Moreover, repair of large, complex abdominal wall hernias by CST augmented with a biologic underlay mesh and a lightweight polypropylene only mesh results in lower recurrence rates compared to historical reports of CST alone.

Keywords

Contaminated hernia repair; Sublay mesh; Biologic mesh; Biologic scaffolds; Noncross-linked porcine dermis; Components separation technique; “Sandwich” procedure

Cite the article

Mart�n Cartes JA, Tamayo-L�pez MJ, Bustos Jim�nez M. Components Separation Technique Associated to a �Sandwich� Procedure in the Treatment of Large and Complex Incisional Hernias and Abdominal Wall Defects. A 30-Case Series. Clin Surg. 2017; 2: 1292.