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Complex abdominal wall reconstruction, harnessing the power of a specialized multidisciplinary team to improve pain and quality of life

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Abstract

Introduction

Patients who require highly complex abdominal wall hernia repair with composite soft tissue free flap coverage represent the most challenging population, and the most difficult to definitively treat. For many, this combined procedure represents their last chance to restore any sense of normalcy to their lives. To date, patient reported post-operative outcomes have been limited in the literature, in particular, quality of life has been an under-reported component of successful management.

Methods

Patient-reported outcomes were analyzed using the 12-question HerQLes survey, a validated hernia-related quality of life survey to assess patient function after complex abdominal wall reconstruction. Using synthetic mesh for structural stability, and microsurgical flaps for soft tissue coverage, ten consecutive heterogeneous patients underwent repair of massive abdominal wall defects. Baseline preoperative HerQLes and numerical pain scores were then compared to those obtained postoperatively (at or greater than 6 months).

Results

All patients experienced improvement in their quality of life and pain scores post operatively with average follow-up at 15.9 months, even in those who experienced complications. All microsurgical flaps survived. There were no hernia recurrences.

Conclusion

Despite the extraordinary preoperative morbidity of massive abdominal wall defects, with an experienced General Surgery and Plastic Surgery multidisciplinary team, these highly complex patients are able to achieve a significant improvement in their pain and quality of life following repair and reconstruction with complex mesh hernia repair and microsurgical free tissue transfer.

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Acknowledgements

We would like to thank Pat Shoda and Susan Lopez for their photography expertise and assistance preparing this manuscript.

Funding

Michael Rosen MD receives research support from Intuitive and Miromatrix, and salary support from the Americas Hernia Society Quality Collaborative (AHSQC). David Krpata MD is a consultant for Medtronic. All other listed authors have no financial disclosures. No funding was received for this article.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, A60 Crile building 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    R. E. Aliotta & R. Gurunluoglu

  2. Department of Surgery, Comprehensive Hernia Center, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    D. Krpata, S. Rosenblatt & M. Rosen

  3. Division of Plastic Surgery, MetroHealth Medical Center, Cleveland, OH, USA

    J. Gatherwright

Authors
  1. R. E. Aliotta
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  2. J. Gatherwright
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  3. D. Krpata
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  4. S. Rosenblatt
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  5. M. Rosen
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  6. R. Gurunluoglu
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Corresponding author

Correspondence to R. Gurunluoglu.

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Conflict of interest

REA declares no conflict of interest. JG declares no conflict of interest. DK declares no conflict of interest. SR declares no conflict of interest. MR declares no conflict of interest. RG declares no conflict of interest.

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The article does not contain any identifiable information and the content is compliant with HIPPA regulations and human rights.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all patients.

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Aliotta, R.E., Gatherwright, J., Krpata, D. et al. Complex abdominal wall reconstruction, harnessing the power of a specialized multidisciplinary team to improve pain and quality of life. Hernia 23, 205–215 (2019). https://doi.org/10.1007/s10029-019-01916-w

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  • DOI: https://doi.org/10.1007/s10029-019-01916-w

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