[Abdominal wall components separation method for closure of complicated abdominal hernias]
D Pantelis1, A Jafari, T O Vilz
1Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universität Bonn, Sigmund- Freud-Str. 25, 53105, Bonn, Deutschland. dimitrios.pantelis@ukb.uni-bonn.de
Background:
The repair of complicated abdominal hernias remains a challenging problem. The components separation technique introduced by Ramirez et al. is an increasingly popular method for autogenous reconstruction of the abdominal wall, especially in combination with epifascial mesh reinforcement.
Patients And Methods:
In a retrospective study carried out at a university hospital, 40 consecutive patients between 2002 and 2010 were analyzed.
Results:
Indications for abdominal reconstruction were fascial defects after secondary healed laparostoma in 22 patients (55%) and fascial defects combined with colostomy reversal after a Hartmann procedure in 10 patients (25%). A total of 9 wound infections (22.5%) occurred and 10 hernia recurrences (10/36 patients) were identified in the follow-up (mean 3.8 years, range 1-9 years). Reconstructions with mesh reinforcement resulted in a lower rate of recurrences (19% with mesh vs 40% without mesh).
Conclusions:
The components separation technique, in combination with epifascial mesh reinforcement as appropriate, is the procedure of choice for most complicated abdominal wall hernias. Therefore, each visceral surgeon should be able to perform this method. Recurrence rates depend on the underlying disease of the patient and the complexity of the hernia.
