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The impact of component separation technique versus no component separation technique on complications and quality of life in the repair of large ventral hernias

Abstract

Background

Component Separation (CST) typically involves incision of one or more fascial planes to generate myofascial advancement flaps to assist with fascial closure in ventral hernia repair (VHR). The aim of this study was to compare peri-operative outcomes and quality of life (QOL) after CST versus patients without CST (No-CST) in large, preperitoneal VHR (PPVHR).

Methods

A prospective, single institution hernia study examined all patients undergoing PPVHR with synthetic mesh. Emergency and contaminated operations were excluded. A case–control cohort was identified using propensity score matching for CST and No-CST. QOL was assessed using the Carolinas Comfort Scale.

Results

The algorithm matched 113 CST cases to 113 No-CST cases. The groups (CST vs No-CST) were similar regarding age, BMI, diabetes, smoking, defect size, mesh size, and follow-up. In univariate analysis, there was no difference in recurrence between the CST and no-CST groups (0.9% vs 0.9%, p = 1.0) or mesh infection (0.9% vs 0.0%, p = 1.0). CST did have more wound complications (29.2% vs 16.1%, p = 0.019). When controlling for panniculectomy and diabetes with multivariate logistic regression, CST continued to have had an increased risk for wound complications (OR 2.27, CI 1.16–4.47). QOL was routinely assessed. The groups were similar pre-operatively with 76.3% of CST patients and 77.8% of No-CST patients having pain (p = 1.0). At 1, 6, 12, 24, and 36 months post-operatively, the groups had equal QOL.

Conclusion

The use of CST versus No-CST in the repair of large VHs results in an increased risk of wound complications but does not increase the hernia recurrence rate. In the largest QOL comparative study to date, CST’s generation of myofascial advancement flaps does not negatively impact patient QOL in the repair of large ventral hernias in the short or long term.

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Author information

Correspondence to B. Todd Heniford.

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Disclosures

Dr. Kercher is on the speakers’ bureau at Bard, Ethicon, and W.L. Gore. Dr. Colavita is on the speakers’ bureau at Allergan. Dr. Augenstein is on the speakers’ bureau at Allergan, Intuitive, Acelity, and W.L. Gore. Dr. Heniford is on the speakers’ bureau at Allergen and W.L. Gore and has received grants from Allergen and W.L. Gore. Drs. Maloney and Schlosser and Ms. Prasad have no conflicts of interest or financial ties to disclose.

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Maloney, S.R., Schlosser, K.A., Prasad, T. et al. The impact of component separation technique versus no component separation technique on complications and quality of life in the repair of large ventral hernias. Surg Endosc 34, 981–987 (2020) doi:10.1007/s00464-019-06892-x

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Keywords

  • Hernia repair
  • Component separation
  • Abdominal wall reconstruction
  • Propensity score match
  • Wound complications