Revising Recommendations and Outcome Measurements after Complex Open Abdominal Wall Reconstruction.

Area of Science:

• Abdominal wall reconstruction
• Surgical outcomes research
• Hernia repair complications

Background:

• Current Ventral Hernia Working Group (VHWG) grading for complex abdominal wall reconstruction focuses narrowly on surgical site occurrence (SSO) and recurrence.
• Existing systems do not adequately assess long-term functional restoration or complication management following complex abdominal wall reconstruction.
• A need exists to evaluate comprehensive outcomes beyond initial SSO and recurrence rates in complex hernia repairs.

Purpose of the Study:

• To establish reoperation rates for complex open abdominal wall reconstruction.
• To compare long-term outcomes with existing Ventral Hernia Working Group (VHWG) grading criteria.
• To identify factors associated with reoperation and long-term success in complex hernia repairs.

Main Methods:

• Retrospective review of 125 complex open abdominal wall reconstructions with loss of domain and >200 cm(2) defects.
• Minimum 24-month follow-up, with an average follow-up of 47 months.
• Analysis of surgical site occurrences (SSO), reoperation rates, and overall restoration success.

Main Results:

• Surgical site occurrence (SSO) rates were 9% (Grade I), 45% (Grade II), and 55% (Grade III), exceeding VHWG published rates.
• Forty-three of 59 patients with complications achieved successful restoration after reoperation, yielding an 87% overall restoration rate.
• Biologic mesh use and a history of infection were independently associated with increased reoperation rates.

Conclusions:

• While SSO rates were higher than VHWG benchmarks, high salvage rates were achieved through reoperation.
• Biologic mesh demonstrated poor outcomes, particularly in contaminated or clean fields, recommending restricted use.
• Modifications to the VHWG grading system and recommendations are suggested to better reflect comprehensive outcomes.