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Comparing Surgical Site Infection for Open and Endoscopic Component Separation

Derek S Palmer, Conner C McDaniel, Navdeep S Samra

    The American Surgeon
    |May 3, 2019
    PubMed

    Insights

    Surgical site infections (SSI) after abdominal wall hernia repair were high, especially with open component separation. Endoscopic component separation technique (ECST) significantly reduced SSI rates compared to the open method.

    Area of Science:

    • Abdominal wall reconstruction
    • Surgical site infections
    • Hernia repair outcomes

    Background:

    • Previous analysis of LSU Health data (2011-2013) showed an overall surgical site infection (SSI) rate of 6.8% for abdominal wall hernia repairs.
    • Specific subsets revealed higher infection rates, notably 26.3% for open component separation (OCS) procedures, which were associated with significant morbidity and costs.

    Purpose of the Study:

    • To evaluate the impact of transitioning from open component separation (OCS) to endoscopic component separation technique (ECST) on surgical site infection (SSI) rates in abdominal wall hernia repairs.
    • To compare the SSI outcomes between OCS and ECST in challenging hernia cases.

    Main Methods:

    • Retrospective analysis of 33 abdominal wall hernia repairs performed between November 2011 and April 2018.
    • Comparison of SSI rates between patients who underwent OCS (n=24) and those who underwent ECST (n=9).

    Main Results:

    • The OCS group had a high SSI rate of 37.5% (9 out of 24 patients).
    • The ECST group demonstrated a significantly lower SSI rate of 0% (0 out of 9 patients) (P = 0.039).
    • These findings align with a 2016 meta-analysis suggesting a benefit of ECST over OCS.

    Conclusions:

    • Endoscopic component separation technique (ECST) is associated with a significant reduction in surgical site infections compared to open component separation (OCS) for complex abdominal wall hernia repairs.
    • The shift towards ECST represents a successful quality improvement initiative, mirroring evidence-based recommendations and improving patient outcomes.

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