Management of difficult abdominal wall problems by components separation methods: a preliminary study in Thailand

Area of Science:

• Abdominal Wall Reconstruction
• Surgical Techniques
• Hernia Repair

Background:

• Acute (open abdomen) and late (ventral hernia) abdominal wall defects present significant surgical challenges.
• Traditional reconstruction methods have varying outcomes.
• Components separation method (CSM) is an autologous tissue repair gaining traction for these complex cases.

Purpose of the Study:

• To evaluate the outcomes of patients with large abdominal wall defects treated with CSM.
• To demonstrate surgical techniques and discuss related issues of CSM.
• To assess the efficacy of CSM in managing acute and late abdominal wall defects.

Main Methods:

• A retrospective analysis of 26 patients treated with CSM between May 2005 and June 2012.
• Patients were categorized into acute (open abdomen) and late (ventral hernia) defect groups.
• No prosthetic mesh was used; various CSM techniques were employed, including standard, modified, and those with rectus abdominis sheath turnover flaps.

Main Results:

• Eight patients (30.8%) had acute defect closure, and 18 (69.2%) underwent late ventral hernia repair.
• CSM facilitated simultaneous closure of fistulae or ostomies in several patients.
• Complications were generally low, with one asymptomatic recurrent ventral hernia (5.6%) in the late repair group.

Conclusions:

• CSM is a viable alternative for complex abdominal wall reconstruction, particularly when prosthetic mesh is contraindicated.
• Advantages include avoidance of mesh and a low risk of infection in contaminated fields.
• CSM is versatile for large defects and associated enteric fistulae or ostomy closures.