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Component separation technique for giant incisional hernia: A systematic review.

Bram Cornette1, Dirk De Bacquer2, Frederik Berrevoet1

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Summary

Component separation technique (CST) for giant abdominal hernias shows comparable surgical site occurrences across methods. The Open Anterior Approach has the highest recurrence rate, while Transversus Abdominis Release offers significant advantages.

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Area of Science:

  • Abdominal surgery
  • Hernia repair
  • Surgical techniques

Background:

  • Giant abdominal hernias present complex surgical challenges.
  • Component separation technique (CST) is increasingly utilized for these defects.
  • Various CST approaches exist, necessitating comparative analysis.

Purpose of the Study:

  • To systematically review and compare outcomes of different component separation techniques for giant abdominal hernias.
  • To evaluate surgical site occurrences (SSO) and recurrence rates among various CST methods.

Main Methods:

  • Systematic review of MedLine and EMBASE databases.
  • Inclusion of 36 observational cohort studies.
  • Data analysis categorized into Open Anterior Approach (OAA), Transversus Abdominis Release (TAR), Laparoscopic Anterior Approach (LAA), and Perforator Preserving Approach (PPA).

Main Results:

  • Surgical Site Occurrences (SSO) prevalence: OAA 21.4%, TAR 23.7%, LAA 20.3%, PPA 16.0%.
  • Recurrence rates: OAA 11.9%, TAR 5.25%, LAA 7.02%, PPA 6.47%.
  • Transversus Abdominis Release (TAR) showed a significant advantage over Open Anterior Approach (OAA) regarding recurrence (p < 0.001).

Conclusions:

  • Surgical site occurrences are comparable across the evaluated component separation techniques.
  • The Open Anterior Approach is associated with the highest recurrence rate.
  • Limitations include a lack of randomized trials and heterogeneous outcome measures, hindering definitive conclusions.