Complex ventral hernia repair with a human acellular dermal matrix and component separation: A case series
Alvaro Garcia1, Anthony Baldoni1
1General Surgery and Abdominal Wall Reconstruction Center of South Florida, 17900 NW 5th St., Suite 201, Pembroke Pines, FL 33029, USA.
Annals of Medicine and Surgery (2012)
|August 20, 2015
Summary
Complex abdominal hernia repair using component separation and human bioprosthetic mesh is effective for high-risk patients. This approach, despite comorbidities and prior repairs, resulted in few recurrences and manageable complications.
Area of Science:
- Abdominal surgery
- Hernia repair
- Biomaterials
Background:
- Complex abdominal hernias present significant surgical challenges, often in patients with multiple comorbidities.
- High-risk patient populations frequently have histories of abdominal infection and previous failed hernia repairs.
- Large fascial defects (average 282 cm²) necessitate advanced repair techniques.
Observation:
- A case series of 19 patients with complex abdominal hernias underwent anterior and posterior component separation with human acellular dermal mesh.
- The majority of patients (95%) had significant comorbidities, including obesity, hypertension, and diabetes.
- Prior abdominal infections (68%) and failed hernia repairs (53%) were common.
Findings:
- Midline abdominal closure was achieved primarily in all cases with minimal tension.
- Early post-operative complications occurred in 11% (pulmonary embolism, hemorrhage), with wound-related issues in 32%.
- Increased patient age and longer operative times predicted early complications.
Implications:
- Component separation reinforced with human bioprosthetic mesh offers a viable solution for high-risk patients with complex abdominal hernias.
- Conservative management of anticipated complications proved effective.
- A low hernia recurrence rate (16%) was observed at a median 2-year follow-up, suggesting the durability of this surgical approach.
