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A stepwise approach based on a rational use of components separation and double mesh prosthesis for incisional hernia repair

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Abstract

Purpose

We aimed to evaluate the results of a protocol for a tension-free reconstruction of the abdominal wall in midline incisional hernia repair, based on the rational association of components separation and prosthesis, independently of the hernia size.

Methods

A total of 100 consecutive patients with midline incisional hernias were prospectively included in the study. Three groups according to the transverse diameter of the defect [group A (<4 cm, N = 18), group B (4–10 cm, N = 59), and group C (>10 cm, N = 23)] were identified.

Results

Components separation was necessary in 54 % of the patients: 16.7 % (3/18) in group A, 59.3 % (35/59) in group B, and 69.6 % (16/23) in group C. Complete tension-free reconstruction was achieved in 87 % of the patients: 94.4 % (17/18) in group A, 91.5 % (54/59) in group B, and 69.6 % (16/23) in group C. Overall morbidity rate was 21 % (21/100) [group A 16.7 % (3/18), group B 22 % (13/59), and group C 21.7 % (5/23)]. Hospital length of stay was 3.7 ± 3.3 days (group A 1.83 ± 1.43 days, group B 3.05 ± 2.11 days, and group C 6.91 ± 4.45 days). Median follow-up was 25 months (interquartile range 12.25–55.25) with overall recurrence of 2 %.

Conclusion

A tension-free abdominal wall reconstruction can be achieved in most cases of small and large midline incisional hernia repair, by a stepwise approach based on a rational association of components separation and double mesh prosthesis, with a low morbidity and recurrence rates.

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Acknowledgments

The authors thank Sara Calvo Rosenstone for helping in editing the manuscript and Ignacio Mahillo-Fernández for the statistical support.

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Authors and Affiliations

  1. Department of Surgery, Clínica de la Concepción, Hospital Universitario “Fundación Jiménez Díaz”, Avda. Reyes Católicos No 2, 28040, Madrid, Spain

    Á. Celdrán, M. J. Fraile, T. Georgiev-Hristov & S. González-Ayora

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  1. Á. Celdrán
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  2. M. J. Fraile
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  3. T. Georgiev-Hristov
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  4. S. González-Ayora
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Correspondence to T. Georgiev-Hristov.

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Celdrán, Á., Fraile, M.J., Georgiev-Hristov, T. et al. A stepwise approach based on a rational use of components separation and double mesh prosthesis for incisional hernia repair. Hernia 20, 201–207 (2016). https://doi.org/10.1007/s10029-015-1438-6

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  • DOI: https://doi.org/10.1007/s10029-015-1438-6

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