Anterior component separation versus posterior component separation with transversus abdominis release for large...

Area of Science:

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

Background:

• Large midline ventral hernias present complex surgical challenges.
• Component separation techniques (CSTs) are utilized for abdominal wall reconstruction.
• Comparing anterior (ACST) and posterior (TAR) CSTs is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the outcomes of open anterior component separation technique (ACST) and posterior component separation technique with transversus abdominis release (TAR) for large midline ventral hernias.
• To evaluate surgical site occurrences (SSO), hernia recurrence, and quality of life (QoL) between ACST and TAR.
• To determine the preferred CST for managing large ventral hernias.

Main Methods:

• Retrospective analysis of 43 patients undergoing elective open CST for large midline ventral hernias (December 2016 - July 2022).
• Patients were divided into ACST (n=22) and TAR (n=21) groups.
• Outcomes assessed included preoperative/intraoperative factors, hospital stay, SSO, hernia recurrence, and QoL (using Carolinas Comfort Scale).

Main Results:

• The TAR group had significantly lower proportions of SSO (19%) compared to the ACST group (50%) (p=0.033).
• Seroma was the most frequent SSO, occurring in 9.5% of TAR patients versus 40.9% of ACST patients (p=0.018).
• No significant differences were observed between groups for surgical site infection, hematoma, wound dehiscence, skin necrosis, hernia recurrence, or QoL.

Conclusions:

• For large midline ventral hernias, TAR is associated with significantly fewer surgical site occurrences compared to ACST.
• Both ACST and TAR yield comparable results regarding hernia recurrence and patient quality of life.
• TAR may be a more preferable technique due to its lower SSO rate.