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Endoscopic versus open component separation: systematic review and meta-analysis.

Noah J Switzer1, Mark A Dykstra, Richdeep S Gill

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Summary

Minimally invasive or endoscopic component separation technique (MICST) shows lower overall wound complications compared to open component separation technique (CST) for complex hernias. While open CST had fewer intra-abdominal abscesses, MICST demonstrated reduced superficial infections and skin issues.

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Area of Science:

  • Abdominal Wall Reconstruction
  • Minimally Invasive Surgery
  • Hernia Repair

Background:

  • Component Separation Technique (CST) is crucial for abdominal wall reconstruction in large, complex hernias.
  • Open CST involves extensive skin flaps, leading to significant ischemic wound complications.
  • Minimally Invasive or Endoscopic Component Separation Technique (MICST) is proposed to reduce post-operative wound complications.

Purpose of the Study:

  • To systematically review and meta-analyze studies comparing open CST and MICST.
  • To evaluate complication rates and procedural outcomes between the two techniques.

Main Methods:

  • Comprehensive literature search of electronic databases for relevant English studies.
  • Inclusion of randomized controlled trials, non-randomized comparison studies, and case series.
  • Methodological quality assessment of controlled studies using Cochrane Risk of Bias tools.

Main Results:

  • Analysis of 63 studies (3,055 patients); 7 controlled studies included in meta-analysis (387 patients).
  • MICST (20.6%) showed lower total wound complication rates than Open CST (34.6%).
  • MICST had significantly lower rates of superficial infections, skin dehiscence, necrosis, hematoma/seroma, fistula, fascial dehiscence, and mortality; open CST had lower intra-abdominal abscess and recurrence rates.

Conclusions:

  • MICST is associated with decreased overall post-operative wound complication rates compared to open CST.
  • MICST demonstrated a significantly decreased rate of fascial dehiscence and shorter procedure time.
  • Further prospective studies are recommended to validate these findings.