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Components Separation for Abdominal Wall Reconstruction: The Pittsburgh Experience, A Review of 311 Consecutive Single Surgeon Cases
Sanjay Naran MD, Patrick Emilife BS, Meghan Quigley BS, Sameer Shakir BS, James Cray Jr. PhD, James Russavage DMD, MD, Vu Nguyen MD
University of Pittsburgh Medical Center
2013-02-28
Presenter: Sanjay Naran, MD
Affidavit:
The above work, in its entirety, is the original work of the resident.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
BACKGROUND:
Components separation is a mainstay for closing complicated abdominal wall defects. We set out to critically analyze our experience with this technique, and identify prognosticators that affect long-term outcomes.
METHODS:
All patients who underwent components separation by a single surgeon (JMR) between 2000-2010 were reviewed. Over 40 data points were collected for each patient and examined as to whether they affected long-term outcomes. These included; BMI, co-morbidities, operative details, and major and minor complications such as hernia recurrence, heamatoma, seroma, infection, wound breakdown, and thrombus.
RESULTS:
311 patients were identified, 51.5% male, with a mean age of 52.4±13.9 years, BMI of 33.1±8.0 kg/m2, and defect size of 189.4±229.8 cm2. 97.1% had a prior abdominal surgery, and 38.5% had a prior mesh placement. 25.5% underwent concurrent bowel enterotomies, and 1.7% required prosthetic reinforcement. Mean post-operative stay was 7.2±5.1 days, and average follow-up was 2.9±2.4 years. Recurrence rate was 20.9%. Post-operative complications included heamatoma (3.8%), seroma (8.4%), ischemia (1.3%), infection (9.2%), superficial wound breakdown (5.9%), and DVT/PE (3.3%). A respiratory co-morbidity (p=0.049) was associated with an increased risk of recurrence. The occurrence of any post-operative complication (p<0.001) significantly increased the likelihood of eventual recurrence. We found no association between adverse outcomes and BMI.
CONCLUSIONS:
We provide a comprehensive review of the largest single surgeon experience utilizing components separation to date. Respiratory co-morbidities significantly increase the risk of recurrence; however, in our expereicne components separation remains a reliable technique even in the setting of co-morbidities thought to be associated with adverse outcomes.
