Skip to main content

Advertisement

SpringerLink
Log in

A single institutional comparison of endoscopic and open abdominal component separation

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The authors analyzed surgical factors and outcomes data in the largest single institutional study comparing endoscopic (ECS) and open component separation (OCS) in ventral hernia repairs (VHR).

Methods

A prospectively maintained database was reviewed, identifying 76 patients who underwent component separation for VHR with mesh from 2010 to 2013: 34 OCS and 42 ECS. Comparisons were made for demographics, surgical risk factors, and peri-operative outcomes. Wound complications and hernia occurrence post-operatively were reviewed. Risk analyses were performed to determine the association of pre-operative risk factors with surgical site occurrences.

Results

Twenty-five ECS patients underwent subsequent laparoscopic hernia repair, and 17 underwent open repair. Operative time for ECS was longer than OCS (334 vs. 239 min; P < 0.001); however, there was no difference in length of stay (4 days in both groups, P = 0.64) and estimated blood loss (ECS: 97 vs. OCS: 93 cc, P = 0.847). In a sub-analysis of ECS patients, those who underwent laparoscopic hernia repair had a 96 min shorter operative time (P < 0.001) and lower EBL (63 vs. 147 cc, P < 0.001) than open repair. Wound complications were 24 % in the ECS (n = 10) and 32 % in OCS group (n = 11). There was one midline hernia recurrence in the ECS group (mean follow-up of 8 months, range 0.5–34.5 months) and no hernia recurrences in the OCS group (mean follow-up 10 months, range 0.5–30 months). Three of the patients in the ECS group developed new lateral abdominal wall hernias post-operatively.

Conclusions

The ECS group had a significantly longer operative time than the OCS group. Post-operative wound complications were similar between ECS and OCS groups. Patients in the ECS group who underwent subsequent laparoscopic VHR had a shorter operative time and blood loss than open repair.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558

    Article  PubMed  Google Scholar 

  2. Daes J (2014) Endoscopic subcutaneous approach to component separation. J Am Coll Surg 218(1):e1–e4

    Article  PubMed  Google Scholar 

  3. Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362(9395):1561–1571

    Article  PubMed  Google Scholar 

  4. Bauer JJ, Harris MT, Gorfine SR, Kreel I (2002) Rives–Stoppa procedure for repair of large incisional hernias: experience with 57 patients. Hernia 6:120–123

    Article  CAS  PubMed  Google Scholar 

  5. Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Recons Surg 86(3):519–526

    Article  CAS  Google Scholar 

  6. Heller L, McNichols CH, Ramirez OM (2012) Components separations. Semin Plast Surg 26(1):25–28

    Article  PubMed Central  PubMed  Google Scholar 

  7. Lowe JB, Garza JR, Bowman JL, Rohrich RJ, Strodel WE (2000) Endoscopically assisted “components separation” for closure of abdominal wall defects. Plast Reconstr Surg 105(2):720–729

    Article  CAS  PubMed  Google Scholar 

  8. Maas SM, de Vries Reilingh TS, van Goor H, de Jong D, Bleichrodt RP (2002) Endoscopically assisted “components separation technique” for the repair of complicated ventral hernias. J Am Coll Surg 194(3):388–390

    Article  PubMed  Google Scholar 

  9. Harth KC, Rosen MJ (2010) Endoscopic versus open component separation in complex abdominal wall reconstruction. Am J Surg 199:342–347

    Article  PubMed  Google Scholar 

  10. Harth KC, Rosen J, Delaney CP, Blatnik JA, Halaweish I, Rosen MJ (2011) Open versus endoscopic component separation: a cost comparison. Surg Endosc 25:2865–2870

    Article  PubMed  Google Scholar 

  11. Albright E, Diaz D, Davenport D, Roth JS (2011) The component separation technique for hernia repair: a comparison of open and endoscopic techniques. Am Surg 77(7):839–843

    PubMed  Google Scholar 

  12. Giurgius M, Bendure L, Davenport DL, Roth JS (2012) The endoscopic component separation technique for hernia repair results in reduced morbidity compared to the open component separation. Hernia 16(1):47–51

    Article  CAS  PubMed  Google Scholar 

  13. Azoury SC, Nguyen HT (2013) Endoscopic component separation. In: Diaz JJ (ed) Abdominal wall defects: prevalence, surgical management strategies and clinical care outcomes. Management strategies, 1st edn. Nova Science, New York, pp 221–233

    Google Scholar 

  14. Rosen MJ, Jin J, McGee MF, Williams C, Marks J, Ponsky JL (2007) Laparoscopic component separation in the single-stage treatment of infected abdominal wall prosthetic removal. Hernia 11(5):435–440

    Article  CAS  PubMed  Google Scholar 

  15. Shestak K, Edington H, Johnson R (2000) The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg 105(2):731–738

    Article  CAS  PubMed  Google Scholar 

  16. Baumann DP, Butler CE (2012) Lateral abdominal wall reconstruction. Semin Plast Surg 26(1):40–48

    Article  PubMed Central  PubMed  Google Scholar 

  17. Rosen MJ, Williams C, Jin J, McGee MF, Schomisch S, Marks J, Ponsky J (2007) Laparoscopic versus open-component separation: a comparative analysis in a porcine model. Am J Surg 194:385–389

    Article  PubMed  Google Scholar 

  18. Milburn ML, Shah PK, Friedman EB, Roth JS, Bochicchio GV, Gorbaty B, Silverman RP (2007) Laparoscopically assisted components separation technique for ventral hernia repair. Hernia 11:157–161

    Article  PubMed  Google Scholar 

  19. Janis JE, O’Neill AC, Ahmad J, Zhong T, Hofer SO (2012) Acellular dermal matrices in abdominal wall reconstruction: a systematic review of the current evidence. Plast Reconstr Surg 130(5 Suppl 2):183S–193S

    Article  CAS  PubMed  Google Scholar 

  20. Skipworth JRA, Vyas S, Uppal L, Floyd D, Shanker A (2014) Improved outcomes in the management of high-risk incisional hernias utilizing biological mesh and soft-tissue reconstruction: a single center experience. World J Surg 38:1026–1034

    Article  CAS  PubMed  Google Scholar 

  21. Darehzereshki A, Goldfarb M, Zehetner J, Moazzez A, Lipham JC, Mason RJ, Katkhouda N (2014) Biologic versus nonbiologic mesh in ventral hernia repair: a systematic review and meta-analysis. World J Surg 38:40–50

    Article  PubMed  Google Scholar 

  22. Helgstand F, Rosenberg J, Kehlet H, Bisgaard T (2013) Outcomes after emergency versus elective ventral hernia repair: a prospective nationwide study. World J Surg 37(10):2273–2279

    Article  Google Scholar 

  23. Sailes FC, Walls J, Guelig D, Mirzabeigi M, Long WD, Crawford A, Moore JH, Copit SE, Tuma GA, Fox J (2010) Synthetic and biological mesh in component separation. Ann Plast Surg 64(5):696–698

    CAS  PubMed  Google Scholar 

  24. Pauli EM, Rosen MJ (2013) Open ventral hernia repair with component separation. Surg Clin North Am 93(5):1111–1133

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Dr. Hien Nguyen, the senior author, had full access to all data in the study.

Disclosures

Drs. Azoury, Dhanasopon, Hui, Tuffaha, Hirose, Magnuson, Liao, Schweitzer, and Nguyen have no conflict of interest or financial ties to disclose. Mrs. De La Cruz, and Paskert have no conflict of interest or financial to disclose.

Dr. Sacks and is consultant speaker for LifeCell Corporation.

Author information

Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Blalock 658, Baltimore, MD, 21287, USA

    Saïd C. Azoury, Andrew P. Dhanasopon, Kenzo Hirose, Thomas H. Magnuson, Monica Lovins, Michael A. Schweitzer & Hien T. Nguyen

  2. Center for Surgical Trials and Outcomes Research (CSTOR), The Johns Hopkins Hospital, Baltimore, MD, USA

    Xuan Hui

  3. School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Carla De La Cruz

  4. Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA

    Sami H. Tuffaha & Justin M. Sacks

  5. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Caiyun Liao

  6. Johns Hopkins Comprehensive Hernia Center, Baltimore, MD, USA

    Hien T. Nguyen

  7. Center for Bioengineering Innovation and Design, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21287, USA

    Hien T. Nguyen

Authors
  1. Saïd C. Azoury
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew P. Dhanasopon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xuan Hui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carla De La Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sami H. Tuffaha
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Justin M. Sacks
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kenzo Hirose
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thomas H. Magnuson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Caiyun Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Monica Lovins
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Michael A. Schweitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hien T. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Saïd C. Azoury.

Additional information

Presented at the SAGES 2014 Annual Meeting, April 2–5, 2014, Salt Lake City, Utah

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Azoury, S.C., Dhanasopon, A.P., Hui, X. et al. A single institutional comparison of endoscopic and open abdominal component separation. Surg Endosc 28, 3349–3358 (2014). https://doi.org/10.1007/s00464-014-3627-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3627-2

Keywords

Search

Navigation