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Complex ventral hernia repair with a human acellular dermal matrix and component separation: A case series.

Garcia A, Baldoni A - Ann Med Surg (Lond) (2015)

Bottom Line: Post-operative complications included 2 adverse events (11%) - one pulmonary embolism and one post-operative hemorrhage requiring transfusion; 6 wound-related complications (32%), 1 seroma (5%) and 1 patient with post-operative ileus (5%).At a median 2-year follow-up, three patients had a documented hernia recurrence (16%) and one patient was deceased due to unrelated causes.Anticipated post-operative complications were managed conservatively and at a median 2-year follow-up, a low rate of hernia recurrence was observed with this approach.

View Article: PubMed Central - PubMed

Affiliation: General Surgery and Abdominal Wall Reconstruction Center of South Florida, 17900 NW 5th St., Suite 201, Pembroke Pines, FL 33029, USA.

ABSTRACT

Unlabelled: We present a case series of 19 patients requiring complex abdominal hernia repairs. Patients presented with challenging clinical histories with 95% having multiple significant comorbidities including overweight or obesity (84%), hypertension (53%), diabetes (42%), cancer (26%), and pulmonary disease (16%). The majority of patients (68%) had prior abdominal infections and 53% had at least one failed prior hernia repair. Upon examination, fascial defects averaged 282 cm(2). Anterior and posterior component separation was performed with placement of a human acellular dermal mesh. Midline abdominal closure under minimal tension was achieved primarily in all cases. Post-operative complications included 2 adverse events (11%) - one pulmonary embolism and one post-operative hemorrhage requiring transfusion; 6 wound-related complications (32%), 1 seroma (5%) and 1 patient with post-operative ileus (5%). Operative intervention was not required in any of the cases and most patients made an uneventful recovery. Increased patient age and longer OR time were independently predictive of early post-operative complications. At a median 2-year follow-up, three patients had a documented hernia recurrence (16%) and one patient was deceased due to unrelated causes.

Conclusion: Patients at high risk for post-operative events due to comorbidities, prior abdominal infection and failed mesh repairs do well following component separation reinforced with a human bioprosthetic mesh. Anticipated post-operative complications were managed conservatively and at a median 2-year follow-up, a low rate of hernia recurrence was observed with this approach.

No MeSH data available.


Related in: MedlinePlus

Mesh fixation: the fixation of the mesh transfacially is accomplished by inserting the Reverdin needle (white arrow) percutaneously through the skin, subcutaneous tissue and anterior fascia and picking the stitches previously placed in the mesh in a U fashion (black arrow).
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fig5: Mesh fixation: the fixation of the mesh transfacially is accomplished by inserting the Reverdin needle (white arrow) percutaneously through the skin, subcutaneous tissue and anterior fascia and picking the stitches previously placed in the mesh in a U fashion (black arrow).

Mentions: In the more recent 4 cases, posterior component separation (Fig. 4), involving release of the posterior sheet of the rectus muscle and preserving the abdominal wall innervation and epigastric circulation, was performed as described by Pauli and Rosen [18]. In these cases, the biologic mesh was placed within the retrorectus space with overlap of at least 10 cm on each side of the midline and fixed in position with transfascial sutures (Fig. 5).


Complex ventral hernia repair with a human acellular dermal matrix and component separation: A case series.

Garcia A, Baldoni A - Ann Med Surg (Lond) (2015)

Mesh fixation: the fixation of the mesh transfacially is accomplished by inserting the Reverdin needle (white arrow) percutaneously through the skin, subcutaneous tissue and anterior fascia and picking the stitches previously placed in the mesh in a U fashion (black arrow).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4539183&req=5

fig5: Mesh fixation: the fixation of the mesh transfacially is accomplished by inserting the Reverdin needle (white arrow) percutaneously through the skin, subcutaneous tissue and anterior fascia and picking the stitches previously placed in the mesh in a U fashion (black arrow).
Mentions: In the more recent 4 cases, posterior component separation (Fig. 4), involving release of the posterior sheet of the rectus muscle and preserving the abdominal wall innervation and epigastric circulation, was performed as described by Pauli and Rosen [18]. In these cases, the biologic mesh was placed within the retrorectus space with overlap of at least 10 cm on each side of the midline and fixed in position with transfascial sutures (Fig. 5).

Bottom Line: Post-operative complications included 2 adverse events (11%) - one pulmonary embolism and one post-operative hemorrhage requiring transfusion; 6 wound-related complications (32%), 1 seroma (5%) and 1 patient with post-operative ileus (5%).At a median 2-year follow-up, three patients had a documented hernia recurrence (16%) and one patient was deceased due to unrelated causes.Anticipated post-operative complications were managed conservatively and at a median 2-year follow-up, a low rate of hernia recurrence was observed with this approach.

View Article: PubMed Central - PubMed

Affiliation: General Surgery and Abdominal Wall Reconstruction Center of South Florida, 17900 NW 5th St., Suite 201, Pembroke Pines, FL 33029, USA.

ABSTRACT

Unlabelled: We present a case series of 19 patients requiring complex abdominal hernia repairs. Patients presented with challenging clinical histories with 95% having multiple significant comorbidities including overweight or obesity (84%), hypertension (53%), diabetes (42%), cancer (26%), and pulmonary disease (16%). The majority of patients (68%) had prior abdominal infections and 53% had at least one failed prior hernia repair. Upon examination, fascial defects averaged 282 cm(2). Anterior and posterior component separation was performed with placement of a human acellular dermal mesh. Midline abdominal closure under minimal tension was achieved primarily in all cases. Post-operative complications included 2 adverse events (11%) - one pulmonary embolism and one post-operative hemorrhage requiring transfusion; 6 wound-related complications (32%), 1 seroma (5%) and 1 patient with post-operative ileus (5%). Operative intervention was not required in any of the cases and most patients made an uneventful recovery. Increased patient age and longer OR time were independently predictive of early post-operative complications. At a median 2-year follow-up, three patients had a documented hernia recurrence (16%) and one patient was deceased due to unrelated causes.

Conclusion: Patients at high risk for post-operative events due to comorbidities, prior abdominal infection and failed mesh repairs do well following component separation reinforced with a human bioprosthetic mesh. Anticipated post-operative complications were managed conservatively and at a median 2-year follow-up, a low rate of hernia recurrence was observed with this approach.

No MeSH data available.


Related in: MedlinePlus