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Open intraperitoneal onlay mesh repair with anterior component separation as a bail-out procedure in the management of complex hernias

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Abstract

Purpose

Surgical repair of complex abdominal wall hernias remains technically demanding and is widely recognized as a risk factor for unfavorable outcomes with high recurrence and morbidity rates. The objective is to assess short- and long-term complications after open intraperitoneal onlay mesh (IPOM) repair combined with bilateral anterior component separation (ACS) for large and difficult incisional hernias, alongside evaluating hernia recurrence rates.

Methods

This retrospective analysis utilized data sourced from Hospital electronic health records and a prospective database at an academic tertiary referral center. Data collection was carried out from patients operated between January 2006 and December 2017. Eligible patients had complex incisional hernias measuring at least 10 cm in their transverse diameter and had an open IPOM repair with bilateral ACS.

Results

In our study group of 45 patients, the 30-day surgical site occurrence (SSO) rate was high (37.8%), primarily consisting of superficial postoperative complications as seroma (17.8%) and wound dehiscence (6.7%). Among six patients (13.3%), wound complications escalated to chronic infected mesh-related problems, leading to complete mesh removal in four cases (8.9%) and partial mesh removal in two cases (4.4%). Regarding long-term complications, five patients (11.1%) developed enterocutaneous fistula. The recurrence rate was modest [5 out of 41 (12.2%)] over a median follow-up period of 99 months.

Conclusions

Despite a high SSO rate, application of the open IPOM technique with ACS could serve as a valuable rescue option for managing large and complex hernias, with acceptable hernia recurrence rates at long-term follow-up.

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Data availability

All authors had access to the data and drafted the manuscript. All authors approved the final version and meet authorship criteria.

References

  1. Lopez-Cano M, Martin-Dominguez LA, Pereira JA, Armengol-Carrasco M, Garcia-Alamino JM (2018) Balancing mesh-related complications and benefits in primary ventral and incisional hernia surgery. A meta-analysis and trial sequential analysis. PLoS ONE 13(6):e0197813. https://doi.org/10.1371/journal.pone.0197813

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237(1):129–135. https://doi.org/10.1097/00000658-200301000-00018

    Article  PubMed  PubMed Central  Google Scholar 

  3. Slater NJ, Montgomery A, Berrevoet F, Carbonell AM, Chang A, Franklin M et al (2013) Criteria for definition of a complex abdominal wall hernia. Hernia 18(1):7–17. https://doi.org/10.1007/s10029-013-1168-6

    Article  PubMed  Google Scholar 

  4. Eriksson A, Rosenberg J, Bisgaard T (2014) Surgical treatment for giant incisional hernia: a qualitative systematic review. Hernia 18(1):31–38. https://doi.org/10.1007/s10029-013-1066-y

    Article  CAS  PubMed  Google Scholar 

  5. Deerenberg EB, Timmermans L, Hogerzeil DP, Slieker JC, Eilers PH, Jeekel J et al (2015) A systematic review of the surgical treatment of large incisional hernia. Hernia 19(1):89–101. https://doi.org/10.1007/s10029-014-1321-x

    Article  CAS  PubMed  Google Scholar 

  6. Liang MK, Holihan JL, Itani K, Alawadi ZM, Gonzalez JR, Askenasy EP et al (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265(1):80–89. https://doi.org/10.1097/SLA.0000000000001701

    Article  PubMed  Google Scholar 

  7. Kockerling F, Lammers B, Weyhe D, Reinpold W, Zarras K, Adolf D et al (2021) What is the outcome of the open IPOM versus sublay technique in the treatment of larger incisional hernias? A propensity score-matched comparison of 9091 patients from the Herniamed Registry. Hernia 25(1):23–31. https://doi.org/10.1007/s10029-020-02143-4

    Article  CAS  PubMed  Google Scholar 

  8. Gillion JF, Fromont G, Verhaeghe R, Tiry P, Binot D, Dugue T et al (2023) Open IPOMs for medium/large incisional ventral hernia repairs in the French Hernia Registry: factors associated with their use and mesh-related outcomes. Hernia. https://doi.org/10.1007/s10029-023-02853-5

    Article  PubMed  Google Scholar 

  9. Lasses Martinez B, Pena Soria MJ, Cabeza Gomez JJ, Jimenez Valladolid D, Flores Gamarra M, Fernandez Perez C et al (2017) Surgical treatment of large incisional hernias with intraperitoneal composite mesh: a cohort study. Hernia 21(2):253–260. https://doi.org/10.1007/s10029-016-1557-8

    Article  CAS  PubMed  Google Scholar 

  10. Fortelny RH, Petter-Puchner AH, Glaser KS, Offner F, Benesch T, Rohr M (2010) Adverse effects of polyvinylidene fluoride-coated polypropylene mesh used for laparoscopic intraperitoneal onlay repair of incisional hernia. Br J Surg 97(7):1140–1145. https://doi.org/10.1002/bjs.7082

    Article  CAS  PubMed  Google Scholar 

  11. Kokotovic D, Bisgaard T, Helgstrand F (2016) Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 316(15):1575–1582. https://doi.org/10.1001/jama.2016.15217

    Article  PubMed  Google Scholar 

  12. Muysoms F, Campanelli G, Champault GG, DeBeaux AC, Dietz UA, Jeekel J et al (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 16(3):239–250. https://doi.org/10.1007/s10029-012-0912-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414. https://doi.org/10.1007/s10029-009-0518-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Haskins IN, Horne CM, Krpata DM, Prabhu AS, Tastaldi L, Perez AJ et al (2018) A call for standardization of wound events reporting following ventral hernia repair. Hernia 22(5):729–736. https://doi.org/10.1007/s10029-018-1748-6

    Article  CAS  PubMed  Google Scholar 

  15. Dias ERM, Rondini GZ, Amaral PHF, Macret JZ, Carvalho JPV, Pivetta LGA et al (2023) Systematic review and meta-analysis of the pre-operative application of botulinum toxin for ventral hernia repair. Hernia 27(4):807–818. https://doi.org/10.1007/s10029-023-02816-w

    Article  CAS  PubMed  Google Scholar 

  16. Renard Y, Lardiere-Deguelte S, de Mestier L, Appere F, Colosio A, Kianmanesh R et al (2016) Management of large incisional hernias with loss of domain: a prospective series of patients prepared by progressive preoperative pneumoperitoneum. Surgery 160(2):426–435. https://doi.org/10.1016/j.surg.2016.03.033

    Article  PubMed  Google Scholar 

  17. Niebuhr H, Malaibari ZO, Kockerling F, Reinpold W, Dag H, Eucker D et al (2022) Intraoperative fascial traction (IFT) for treatment of large ventral hernias: a retrospective analysis of 50 cases. Chirurg 93(3):292–298. https://doi.org/10.1007/s00104-021-01552-0

    Article  PubMed  Google Scholar 

  18. Kockerling F, Lammers B (2018) Open intraperitoneal onlay mesh (IPOM) technique for incisional hernia repair. Front Surg 5:66. https://doi.org/10.3389/fsurg.2018.00066

    Article  PubMed  PubMed Central  Google Scholar 

  19. Toma M, Oprea V, Grad O, Staines H, Bucuri CE, Andercou O et al (2023) Early outcomes of open anterior versus posterior components separation with transversus abdominis release for large median incisional hernias: a retrospective stepwise analysis. Hernia. https://doi.org/10.1007/s10029-023-02920-x

    Article  PubMed  Google Scholar 

  20. Bernard C, Polliand C, Mutelica L, Champault G (2007) Repair of giant incisional abdominal wall hernias using open intraperitoneal mesh. Hernia 11(4):315–320. https://doi.org/10.1007/s10029-007-0222-7

    Article  CAS  PubMed  Google Scholar 

  21. Halm JA, de Wall LL, Steyerberg EW, Jeekel J, Lange JF (2007) Intraperitoneal polypropylene mesh hernia repair complicates subsequent abdominal surgery. World J Surg 31(2):423–429. https://doi.org/10.1007/s00268-006-0317-9. (discussion 30)

    Article  CAS  PubMed  Google Scholar 

  22. Fafaj A, Petro CC, Tastaldi L, Alkhatib H, AlMarzooqi R, Olson MA et al (2020) Intraperitoneal versus retromuscular mesh placement for open incisional hernias: an analysis of the Americas Hernia Society Quality Collaborative. Br J Surg 107(9):1123–1129. https://doi.org/10.1002/bjs.11560

    Article  CAS  PubMed  Google Scholar 

  23. Gala J, Nichat P, Bhandarwar A, Dhimole N, Bhat R, Muley G (2022) Single institute experiences in anterior and posterior component separation technique for the large ventral hernia: A retrospective review. Asian J Surg 45(3):854–859. https://doi.org/10.1016/j.asjsur.2021.07.042

    Article  PubMed  Google Scholar 

  24. Sacco JM, Ayuso SA, Salvino MJ, Scarola GT, Ku D, Tawkaliyar R et al (2023) Preservation of deep epigastric perforators during anterior component separation technique (ACST) results in equivalent wound complications compared to transversus abdominis release (TAR). Hernia 27(4):819–827. https://doi.org/10.1007/s10029-023-02811-1

    Article  CAS  PubMed  Google Scholar 

  25. Helgstrand F, Rosenberg J, Kehlet H, Strandfelt P, Bisgaard T (2012) Reoperation versus clinical recurrence rate after ventral hernia repair. Ann Surg 256(6):955–958. https://doi.org/10.1097/SLA.0b013e318254f5b9

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium

    M. Vierstraete, A. Molnar & F. Berrevoet

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  1. M. Vierstraete
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  2. A. Molnar
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  3. F. Berrevoet
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Correspondence to M. Vierstraete.

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This study has been approved by the Ethics Committee of Ghent University Hospital (BC-09636/B6702021000215).

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This study has been approved by the Ethics Committee of Ghent University Hospital (BC-09636/B6702021000215).

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Vierstraete, M., Molnar, A. & Berrevoet, F. Open intraperitoneal onlay mesh repair with anterior component separation as a bail-out procedure in the management of complex hernias. Hernia (2024). https://doi.org/10.1007/s10029-024-03033-9

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