TY - JOUR
T1 - Violation of the rectus complex is not a contraindication to component separation for abdominal wall reconstruction
AU - Garvey, Patrick B.
AU - Bailey, Chad M.
AU - Baumann, Donald P.
AU - Liu, Jun
AU - Butler, Charles E.
PY - 2012/2
Y1 - 2012/2
N2 - Background: Component separation (CS) is an effective technique for reconstructing complex abdominal wall defects. Violation of the rectus abdominis complex is considered a contraindication for CS, but we hypothesized that patients have similar outcomes with or without rectus complex violation. Study Design: We retrospectively studied all consecutive patients who underwent CS for abdominal wall reconstruction during 8 years and compared outcomes of patients with and without rectus violation. Primary outcomes measures included complications and hernia recurrence. Logistic regression analysis identified potential associations between patient, defect, and reconstructive characteristics and surgical outcomes. Results: One hundred sixty-nine patients were included: 115 (68%) with and 54 (32%) without rectus violation. Mean follow-up was 21.3 ± 14.5 months. Patient and defect characteristics were similar, except for the rectus violation group having a higher body mass index. Overall complication rates were similar in the violation (24.3%) and nonviolation (24.0%) groups, as were the respective rates of recurrent hernia (7.8% vs 9.2%; p = 0.79), abdominal bulge (3.5% vs 5.6%; p = 0.71), skin dehiscence (20.0% vs 22.2%; p = 0.74), skin necrosis (6.1% vs 3.7%; p = 0.72), cellulitis (7.8% vs 9.2%; p = 0.75), and abscess (12.3% vs 9.2%; p = 0.58). Regression analysis demonstrated body mass index to be the only factor predictive of complications. Conclusions: CS surgical outcomes were similar whether or not the rectus complex was violated. To our knowledge, this study is the first to evaluate the effects of rectus violation on surgical outcomes in CS patients. Surgeons should not routinely avoid CS when the rectus complex is violated.
AB - Background: Component separation (CS) is an effective technique for reconstructing complex abdominal wall defects. Violation of the rectus abdominis complex is considered a contraindication for CS, but we hypothesized that patients have similar outcomes with or without rectus complex violation. Study Design: We retrospectively studied all consecutive patients who underwent CS for abdominal wall reconstruction during 8 years and compared outcomes of patients with and without rectus violation. Primary outcomes measures included complications and hernia recurrence. Logistic regression analysis identified potential associations between patient, defect, and reconstructive characteristics and surgical outcomes. Results: One hundred sixty-nine patients were included: 115 (68%) with and 54 (32%) without rectus violation. Mean follow-up was 21.3 ± 14.5 months. Patient and defect characteristics were similar, except for the rectus violation group having a higher body mass index. Overall complication rates were similar in the violation (24.3%) and nonviolation (24.0%) groups, as were the respective rates of recurrent hernia (7.8% vs 9.2%; p = 0.79), abdominal bulge (3.5% vs 5.6%; p = 0.71), skin dehiscence (20.0% vs 22.2%; p = 0.74), skin necrosis (6.1% vs 3.7%; p = 0.72), cellulitis (7.8% vs 9.2%; p = 0.75), and abscess (12.3% vs 9.2%; p = 0.58). Regression analysis demonstrated body mass index to be the only factor predictive of complications. Conclusions: CS surgical outcomes were similar whether or not the rectus complex was violated. To our knowledge, this study is the first to evaluate the effects of rectus violation on surgical outcomes in CS patients. Surgeons should not routinely avoid CS when the rectus complex is violated.
KW - BMI
KW - body mass index
KW - component separation
KW - CS
KW - gastrostomy/jejunostomy tube
KW - GT/JT
UR - http://www.scopus.com/inward/record.url?scp=84856089056&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84856089056&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2011.10.015
DO - 10.1016/j.jamcollsurg.2011.10.015
M3 - Article
C2 - 22169002
AN - SCOPUS:84856089056
VL - 214
SP - 131
EP - 139
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
SN - 1072-7515
IS - 2
ER -