Comparing Surgical Site Infection for Open and Endoscopic Component Separation.

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.