Outcome of components separation for contaminated complex abdominal wall defects
Tóm tắt
Contaminated large abdominal wall defects can pose a formidable challenge to the surgeon. This study compared the outcome of components separation (CS) for complex ventral defects with or without contamination. A retrospective review was conducted of all patients who underwent CS over an 8-year period. Pre-operative factors such as the presence/absence of contamination were analyzed for their effect on length of hospitalization, readmission rate, post-operative complications, re-intervention rate, and long-term recurrence. A total of 34 patients was analyzed. There were 18 males (53%) with a mean age of 57 years. Mean body mass index was 31 kg/m2. Seventeen patients (50%) had prior repair (mean 2.1 repairs per patient, median 2). Mean size of abdominal defect was 255 cm2. Out of the 34 patients, 13 had infected or contaminated defects, including 5 patients with infected mesh. Length of stay was longer in the contaminated group (11.1 vs 3.1 days, P < 0.01). A higher complication rate was noted in the setting of contamination (77 vs 38%, P = 0.03). During a mean follow-up of 47 months, no difference was noted in the re-intervention rate (38 vs 29%, P = 0.70) or long-term recurrence rate of the defect (8 vs 5%, P = 1.0) (contaminated vs non-contaminated group, respectively). CS is a good option for closure of large contaminated complex abdominal wall defects. Despite an increased risk of postoperative complications and longer hospitalization length, long-term outcomes are favorable.
Tài liệu tham khảo
Ramirez OM, Ruas E, Dellon AL (1990) Components separation method for closure of abdominal wall defects: an anatomic and clinical study. Plast Reconstr Surg 86(3):519–526
Shabatian H, Lee DJ, Abbas MA (2008) Components separation: a solution to complex abdominal wall defects. Am Surg 74(10):912–916
Poulakidas S, Kowal-Vern A (2009) Component separation technique for abdominal wall reconstruction in burn patients with decompressive laparotomies. J Trauma 67(6):1435–1438
Vargo D (2004) Component separation in the management of the difficult abdominal wall. Am J Surg 188(6):633–637
de Vries Reilingh TS, van Goor H, Rosman C, Bemelmans MH, de Jong D, van Nieuwenhoven EJ, van Engeland MI, Bleichrodt RP (2008) Components separation technique for the repair of large abdominal wall hernias. J Am Coll Surg 196(1):32–37
Ewart CJ, Lankford AB, Gamboa MG (2003) Successful closure of abdominal wall hernias using the components separation technique. Ann Plast Surg 50(3):269–273
de Vries Reilingh TS, van Goor H, Charbon JA, Rosman C, Hesselink EJ, van der Wilt GJ, Bleichrodt RP (2007) Repair of giant midline abdominal wall hernias: components separation technique versus prosthetic repair: interim analysis of a randomized controlled trial. World J Surg 31(4):756–763
Voigt M, Andree C, Galla TJ, Walgenback KJ, Stark GB (2001) Reconstruction of abdominal-wall midline defects: the abdominal wall components separation (in German). Zentralbl Chir 126(12):1000–1004
Girotto JA, Ko MJ, Redett R, Muehlberger T, Talamini M, Chang B (1999) Closure of chronic abdominal wall defects: a long-term evaluation of the components separation method. Ann Plast Surg 42(4):385–395
Ko JH, Wang EC, Salvay DM, Paul BC, Dumanian GA (2009) Abdominal wall reconstruction: lessons learned from 200 “components separation” procedures. Arch Surg 144(11):1047–1055
Buck DW 2nd, Steinberg JP, Fryer J, Dumanian GA (2010) Operative management of massive hernias with associated distended bowel. Am J Surg 200(2):258–264
Llaguna OH, Avgerinos DV, Lugo JZ, Matatov T, Abbadessa B, Martz JE, Leitman IM (2010) Incidence and risk factors for the development of incisional hernia following elective laparoscopic versus open colon resections. Am J Surg 200(2):265–269
Halm JA, Lip H, Schmitz PI, Jeekel J (2009) Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision. Hernia 13(3):275–280
Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitude. Br J Surg 72(1):70–71
Anthony T, Bergen PC, Kim LT et al (2000) Factors affecting recurrence following incisional herniorrhaphy. World J Surg 24(1):95–101
Paul A, Korenkov M, Peters S, Köhler L, Fischer S, Troidl H (1998) Unacceptable results of the Mayo procedure for repair of abdominal incisional hernias. Eur J Surg 164(5):361–367
Read RC, Yoder G (1989) Recent trends in the management of incisional herniation. Arch Surg 124(4):485–488
van der Linden FT, van Vroonhoven TJ (1988) Long-term results after surgical correction of incisional hernia. Neth J Surg 40(5):127–129
Luijendijk RW, Hop WC, van den Tol MP et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343(6):392–398
Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240(4):578–585
Sajid MS, Bokhari SA, Mallick AS, Cheek E, Baig MK (2009) Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg 197(1):64–72
Patton JH Jr, Berry S, Kralovich KA (2007) Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions. Am J Surg 193(3):360–363
Lowe JB III (2006) Updated algorithm for abdominal wall reconstruction. Clin Plast Surg 33(2):225–240
Jin J, Rosen MJ, Blatnik J, McGee M, Williams CP, Marks J, Ponsky J (2007) Use of Acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes? J Am Coll Surg 6(2):654–660
Kim H, Bruen K, Vargo D (2006) Acellular dermal matrix in the management of high-risk abdominal wall defects. Am J Surg 192:706–709
Patton JH, Berry S, Kralovich KA (2007) Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions. Am J Surg 193(3):360–363
Buinewicz B, Rosen B (2004) Acellular cadaveric dermis (AlloDerm): a new alternative for abdominal hernia repair. Ann Plast Surg 52(2):188–194
Mathes SJ, Steinwald PM, Foster RD, Hoffman WY, Anthny JP (2000) Complex abdominal wall reconstruction: a comparison of flap and mesh closure. Ann Surg 232(4):586–596
Ger R, Duboys E (1983) The prevention and repair of large abdominal-wall defects by muscle transposition: a preliminary communication. Plast Reconstr Surg 72(2):170–178
Williams JK, Carlson GW, DeChalain T, Howell R, Coleman JJ (1998) Role of tensor fasciae latae in abdominal wall reconstruction. Plast Reconstr Surg 101(3):713–718
Nahai E, Hill HL, Hester TR (1979) Experiences with tensor fasciae latae flap. Plast Reconstr Surg 63(6):788–799
Ninkovi M, Kronberger P, Harpf C, Rumer A, Anderl H (1998) Free innervated latissimus dorsi muscle flap for reconstruction of full-thickness abdominal wall defects. Plast Reconstr Surg 101(4):971–978
Disa JJ, Goldberg NH, Carlton JM, Robertson BC, Slezak S (1998) Restoring abdominal wall integrity in contaminated tissue-deficient wounds using autologous fascia grafts. Plast Reconstr Surg 101(4):979–986
Alaedeen DI, Lipman J, Medalie D, Rosen MJ (2007) The single-staged approach to the surgical management of abdominal wall hernias in contaminated fields. Hernia 11(1):41–45
Lowe JB 3rd, Lowe JB, Baty JD, Garza JR (2003) Risks associated with components separation for closure of complex abdominal wall defects. Plast Reconstr Surg 111(3):1276–1283