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A retrospective comparison of outcomes after open anterior and posterior component separation by a single surgical team

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Abstract

Purpose

While both anterior and posterior component separation techniques aid the repair of large ventral hernias, their outcomes can be remarkably dissimilar in terms of wound morbidity. We describe outcomes after open component separation by a single surgical team over the entire breadth of our experience.

Methods

We queried a prospectively maintained database for ventral hernias who received an open bilateral component separation between January 2014 and January 2020. A retrospective review was performed to analyze patient demographics, perioperative events, adverse outcomes, and recurrence.

Results

One hundred twenty-seven patients met the inclusion criteria of which 44 underwent anterior component separation (ACS) and 83 underwent posterior component separation (PCS). The two groups were broadly similar in terms of demographic and hernia-related variables. Mesh:defect area ratios, operative time, and estimated intraoperative blood loss were higher in the PCS group. The ACS group had more frequent use of drains which remained in situ for longer, along with a longer hospital stay. Surgical site occurrences (SSOs), including those needing procedural intervention (SSOPIs) were significantly more common after ACS. This group was also more likely to undergo a reoperation within 30 days of index repair. A single recurrence was noted in the ACS group after a mean follow-up duration of 43 months.

Conclusions

Open PCS may be more technically demanding than ACS, but it has a lower risk of postoperative morbidity and reoperation. While we now utilize PCS more frequently in our practice, ACS remains an important tool in our armamentarium.

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Data availability

The data is being maintained in a local database, and details are available at request from the corresponding author with masked identifying details.

Code availability

No custom software of code was employed for this research work.

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Authors and Affiliations

  1. Fortis Healthcare, Mumbai, India

    Ramesh Punjani

  2. Department of General Surgery, Grant Medical College & Sir JJ Group of Hospitals, 6th Floor, Main Hospital Building, Sir JJ Hospital Campus, Byculla, Mumbai, 400008, India

    Eham Arora

  3. University of South Florida, Tampa, FL, USA

    Emily Coughlin

  4. Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    Rahul Mhaskar

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  2. Eham Arora
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  4. Rahul Mhaskar
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Contributions

Ramesh Punjani and Eham Arora contributed to the study conception and design. Material preparation and data acquisition were performed by Eham Arora, Emily Coughlin, and Rahul Mhaskar. Analysis and interpretation of data were performed by Ramesh Punjani, Eham Arora, and Rahul Mhaskar. The first draft of the manuscript was written by Eham Arora, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Eham Arora.

Ethics declarations

Ethics approval

An institutional ethics committee approval was obtained for this retrospective analysis of data. All procedures being performed as a part of the study were a part of routine care. This research work is compliant with STROBE guidelines for observational studies.

Informed consent for participation and publication.

Prior to surgical intervention, all participating patients have consented to undergo the procedural interventions described as well as the collection of their data and its subsequent analysis and publication.

Conflict of interest

• Dr. Ramesh Punjani declares no competing interests.

• Dr. Eham Arora has received honoraria for speaking engagements from Johnson & Johnson Pvt Ltd, India and is a partner in HerniaCAT Surgical Radiology Inc. This is beyond the scope of the submitted work.

• Ms. Emily Coughlin declares no competing interests.

• Dr. Rahul Mhaskar declares no competing interests.

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Punjani, R., Arora, E., Coughlin, E. et al. A retrospective comparison of outcomes after open anterior and posterior component separation by a single surgical team. Langenbecks Arch Surg 407, 1701–1709 (2022). https://doi.org/10.1007/s00423-022-02438-3

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  • DOI: https://doi.org/10.1007/s00423-022-02438-3

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