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Management and Outcomes of Abdominal Wall Reconstruction in Ehlers-Danlos Syndrome: A Scoping Review
Andrew Hannoudi1, Louie Mekani2, Halah Z Keramane2
1Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania; School of Medicine, Wayne State University, Detroit, Michigan.
Introduction:
The purpose of this study is to evaluate the current body of literature describing abdominal wall reconstruction management and outcomes in patients with Ehlers-Danlos Syndrome (EDS) to guide future surgical recommendations for this vulnerable population.
Methods:
In accordance with PRISMA-ScR guidelines, a scoping review was conducted in May 2026 using PubMed, Cochrane, Scopus, and Embase. We identified literature that discussed the operative management and postoperative outcomes of abdominal wall reconstruction in patients with EDS. Studies were screened and data were extracted by two independent reviewers. Data included study, patient, and operative characteristics, in addition to postoperative outcomes.
Results:
Nine studies (six case reports and three case series) comprising 28 patients in total were included in this study. The most reported reconstructive technique was mesh reinforcement, primarily synthetic mesh, and most commonly retromuscular or sublay positioning. Other described techniques included oversized mesh reinforcement (mean 399 cm2 mesh surface area for a mean defect size of 3 × 5 cm, reported in a single case series of 14 patients), meticulous suture technique, component separation, multilayer fascial closure, and flap-based reconstruction (specifically when a contaminated defect was unsuitable for mesh use). Dehiscence was reported in six of the nine studies, representing the most commonly reported complication. Hernia recurrence was rarely reported, although statistical comparisons between postoperative outcomes were limited by small sample size.
Conclusions:
Oversized mesh augmentation and meticulous tissue handling were among the operative strategies described in the available literature on abdominal wall reconstruction for patients with EDS. This review is composed solely of case reports and case series. Future comparative studies are necessary to help generate algorithmic surgical approaches for the study population.
