Current practices in complex abdominal wall reconstruction in the Americas: need for national guidelines?

Area of Science:

• Abdominal Wall Reconstruction
• Surgical Techniques
• Hernia Repair

Background:

• Component separation (CS) is a key surgical technique for hernia repair.
• Standardized criteria for CS training, mesh selection, and patient selection are lacking.
• This study investigates CS utilization trends among practicing surgeons.

Purpose of the Study:

• To identify trends in component separation (CS) utilization.
• To analyze variations in CS technique and mesh choice based on surgeon characteristics.
• To highlight the need for standardized CS guidelines.

Main Methods:

• An online survey was distributed to members of the Americas Hernia Society.
• Responders were stratified by experience, practice type, and CS procedure volume.
• Chi-squared tests analyzed associations between surgeon characteristics and outcomes.

Main Results:

• 275 surgeons responded; 66% identified as general surgeons, 28% as hernia surgeons.
• Posterior component separation (PCS) was most common (67%); endoscopic ACS was least common (3%).
• Hernia/high-volume surgeons favored synthetic mesh in contaminated fields, while general/low-volume surgeons preferred biologic mesh.

Conclusions:

• Component separation (CS) use varies significantly among surgeons.
• Posterior component separation (PCS) is prevalent, particularly among hernia and high-volume surgeons.
• Standardization of CS training, indications, and patient selection is crucial.