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Components Separation for Abdominal Wall Reconstruction: Outcomes and Risk Factors - A Review of 605 Single Institution Cases
Sanjay Naran, MD; Sameer Shakir, BS; Patrick Emelife, BS; Meghan Quigley, MD; James Russavage, DMD, MD; Ernest Manders, MD; J Peter Rubin, MD; Carolyn De La Cruz, MD; Michael Gimbel, MD; Vu Nguyen, MD
University of Pittsburgh
2014-03-02
Presenter: Sanjay Naran MD
Affidavit:
The above work, in its entirety, represents the work of the resident
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Components separation is a mainstay for closing complicated midline and para-median abdominal wall defects. We critically analyze our institution's experience with this operative technique, and identify complication risk factors.
We reviewed patients who presented between 2000-2010. Over 40 data points were collected for each patient, including demographics, BMI, co-morbidities, operative details, and major and minor complications including hernia recurrence, heamatoma, seroma, ischemia, infection, superficial wound breakdown, and DVT/PE.
605 patients qualified, 51.1% of which were female, with a mean age of 53.6±13.45 years, BMI of 32.7±7.8 kg/m2, and defect width of 12±2 cm. 85% had prior abdominal surgery, and 31.7% prior mesh placement. Complications included heamatoma (3.8%), seroma (6.4%), ischemia (3.0%), infection (13.3%), superficial wound breakdown (5.5%), and DVT/PE (3.0%). Respiratory co-morbidity (p=0.001) increased risk of hernia recurrence (OR=2.49). Prior use of prosthetic (p=0.001, OR=2.01), or use at the time of separation (p=0.048, OR=1.73), were significant predictors of recurrence. Seroma was more likely in males, and ischemia more likely in patients with a higher BMI (p=0.043), ASA Classification >2 (p=0.035), and an endocrine disorder (p=0.004). Males (p=0.005), high BMI patients (p=0.015) and large defect area patients (p=0.022) were more likely to experience any complication.
Patients with respiratory co-morbidities, prior use of a prosthetic, and use of a prosthetic at the time of separation, are significantly more likely to have hernia recurrence; however, in our cohort the components separation technique remains a reliable method of abdominal wall reconstruction even in the setting of co-morbidities thought to be associated with recurrence.
