Components separation technique utilizing an intraperitoneal biologic and an onlay lightweight polypropylene mesh: A sandwich technique

Lee M. Morris, K. A. LeBlanc

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Purpose Reconstruction of large, complex abdominal wall hernias is an ongoing challenge. Primary closure of such hernias is often not possible. The components separation technique (CST) is a practical option, however, recurrence rates remain unacceptably high. In an attempt to reduce recurrences, we added a biologic underlay mesh and a lightweight polypropylene onlay mesh to the traditional CST. Methods Patients with a large hernia defect with or without multiple recurrences were selected to undergo a CST augmented with an acellular porcine dermal collagen mesh underlay. Following midline abdominal closure, a lightweight, large-pore polypropylene onlay mesh was fixed to the abdominal fascia. The skin and subcutaneous layers were closed over two sump drains and two closed suction drains. Results Fifty-one patients underwent a mesh-reinforced CST from May 2006 to June 2010. The study population averaged 57.9 ± 1.5 years of age with 24 males and 27 females, BMI of 34.3 ± 0.9 kg/m2, ASA score of 2.62 ± 0.08, 29 % were smokers, 29 % were diabetic, and 69 % had at least one previous abdominal wall hernia repair. Operative time averaged 196.5 ± 7.2 min with a blood loss of 318 ± 24 mL, and average hernia defect size of 301 ± 31 cm 2. Length of follow-up averaged 20.6 ± 2.1 months; surgical site occurrences were identified in 39 %, most commonly from skin necrosis. Hernia recurrence rate was 3.9 %. Conclusions Repair of large, complex abdominal wall hernias by CST augmented with a biologic underlay mesh and a lightweight polypropylene onlay mesh results in lower recurrence rates compared to historical reports of CST alone.

Original languageEnglish (US)
Pages (from-to)45-51
Number of pages7
JournalHernia
Volume17
Issue number1
DOIs
StatePublished - Feb 1 2013

Keywords

  • Biologic mesh
  • Components separation technique
  • Ventral hernia

ASJC Scopus subject areas

  • Surgery

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