Minimally invasive component separation with inlay bioprosthetic mesh (MICSIB) for complex abdominal wall reconstruction

Background: Ventral hernia repair can be challenging, particularly in patients with serious comorbidity. Minimally invasive component separation with inlay bioprosthetic mesh (MICSIB) uses tunnel incisions for external oblique aponeurosis release. It preserves both the rectus abdominis myocutaneous perforator vessels that supply the overlying skin and the connection between the subcutaneous fat and anterior rectus sheath, thereby reducing subcutaneous dead space and potentially improving overlying skin flap vascularity. Inlay bioprosthetic mesh reinforces the musculofascial repair. This study evaluated surgical outcomes of the technique used to repair challenging ventral hernias in cancer patients. Methods: Data from all patients who underwent minimally invasive component separation with inlay bioprosthetic mesh abdominal wall reconstruction from 2007 to 2010 were analyzed. Surgical outcomes assessed included wound complications, hernia recurrence, and repair-site bulge/laxity. Results: Thirty-eight cancer patients (mean age, 63.3 years) considered at high risk for wound healing complications and hernia recurrence were included: 80 percent had preexisting medical comorbidities, 42 percent had infected or contaminated defects, and 26 percent had previous ventral hernia repairs. Despite the mean fascial defect size of 494 ± 229 cm, only seven patients required a bridged repair. During a mean follow-up of 12.4 months, three patients (8 percent) required operative interventions, and nonoperative complications occurred in eight (21 percent). None developed a postoperative laxity/bulge; one (3 percent) had a hernia recurrence requiring operative repair. Conclusion: Minimally invasive component separation with inlay bioprosthetic mesh yields acceptable early outcomes in complex patients, likely because it reduces subcutaneous dead space, preserves the vascularity of overlying skin, and reinforces the musculofascial repair with mesh.