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Modified components separation technique: experience treating large, complex ventral hernias at a University Hospital

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Abstract

Background

An increasing number of patients have large or complex abdominal wall defects. Component separation technique (CST) is a very effective method for reconstructing complex midline abdominal wall defects in a manner that restores innervated muscle function without excessive tension. Our goal is to show our results by a modified CST for treating large ventral hernias.

Materials and methods

A total of 351 patients with complex ventral hernias have been treated over a 10-year period. Pre- and postoperative CT scans were performed in all patients. All ventral hernias were W3, according to the EHS classification 1. We analyzed demographic variables, co-morbidities, hernia characteristics, operative, and postoperative variables.

Results

One hundred and seventy patients (48.4%) were men; the average age of the study population was 51.6 ± 23.2 years with an average BMI of 32.3 ± 1.3. The hernia was located in the midline in 321 cases (91.5%) versus the flank in 30 (8.5%). In 45 patients, preoperative botulinum toxin (BT) and progressive pneumoperitoneum (PPP) were needed due to giant hernia defects when the VIH/VAC ratio was >20%. Postoperative complications related to the surgical site were seroma (35.1%), hematoma (9.1%), infection (7.2%), and wound necrosis (8.8%). Complications related to the repair were evisceration in 3 patients (1.1%), small bowel fistula in 4 patients (1.5%), 11 cases of mesh infection (2.9%), and abdominal compartment syndrome (ACS) in 2 patients. There were 29 hernia recurrences (8.2%) with a mean follow-up of 31.6 ± 8.1 months.

Conclusion

The modified CST is an effective strategy for managing complex ventral hernias that enables primary fascial closure with low rates of morbidity and hernia recurrence.

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Fig. 1

Source from [13]

Fig. 2

Source from [34]

Fig. 3

Source from [34]

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Acknowledgements

Thanks to Fernando Carbonell who created the Abdominal Wall Unit in our hospital and shared his advices and love for surgery. The authors also thanks Hobart W. Harris for his editorial input; he should be one more of the authors.

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Authors and Affiliations

  1. Unit of Abdominal wall surgery, La Fe Universitary and Politechnic Hospital, Valencia, Spain

    A. Torregrosa-Gallud, J. Sancho Muriel, J. Bueno-Lledó, P. García Pastor, J. Iserte-Hernandez, S. Bonafé-Diana & O. Carreño-Sáenz

  2. IVO, Valencia, Spain

    F. Carbonell-Tatay

Authors
  1. A. Torregrosa-Gallud
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  2. J. Sancho Muriel
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  3. J. Bueno-Lledó
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  6. S. Bonafé-Diana
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Correspondence to A. Torregrosa-Gallud.

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Torregrosa-Gallud, A., Sancho Muriel, J., Bueno-Lledó, J. et al. Modified components separation technique: experience treating large, complex ventral hernias at a University Hospital. Hernia 21, 601–608 (2017). https://doi.org/10.1007/s10029-017-1619-6

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