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Early outcomes of open anterior versus posterior components separation with transversus abdominis release for large median incisional hernias: a retrospective stepwise analysis

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Abstract

Background

Complex incisional hernia is still a debatable topic, with increasing incidence and an increased local and systemic postoperative morbidity and mortality. The size of the defect is a risk factor for both difficult closure and 30-day readmission due to complications. The main option for closure such defect is a mesh augmented component separation technique. The goal was to evaluate 30-day wound events and general complications including 90 days mortality.

Material and methods

We present a retrospective study that includes patients from two different university hospitals who underwent open incisional hernia repair with anterior component or posterior component separation between January 2015 and December 2021. Only non-contaminated adult patients (over 18 years old) with postoperative primary or recurrent median abdominal wall defects larger than 6 cm and with complete fascial closure were included. Demographics (age, gender, Body Mass Index—BMI, American Society of Anesthesiologists Classification—ASA score), recurrence rank, and co-morbidities), operative details, patient outcomes complications were collected. A native abdomen/pelvis computerized tomography (CT) scan was performed preoperatively in all patients and the anatomy of the defect and volumetry (abdominal cavity volume, incisional hernia volume and peritoneal volume) were evaluated. One of the component separation technique was performed according to Carbonell’s equation.

Results

Two hundred and two patients (101 from each group) were included. The patients with posterior component separation were more comorbid and with larger defects. The procedure was longer with 80 min but overall length of hospital stay shorter (p < 0.001) for posterior component separation. Seroma, hematoma and skin necrosis were equally distributed for both group of patients and there was no direct relation to surgery (OR 0.887, 95% CI 0.370–2.125, p = 0.788; OR 1.50, 95% CI 0.677–3.33, p = 0.318 and OR 0.386, 95% CI 0.117–1.276, p = 0.119). Surgical Site Infection rate was increased for anterior component separation (p =0.004).

Conclusion

Complex incisional hernia repair is a challenge given by a large amount of wound complications. Choosing between anterior and posterior component separation is still a source of significant debate. We were not able to depict significant different rates of complications between the procedures and we couldn’t find any specific factor related to complications.

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Data availability

Data are available and can be provided by the corresponding author by request.

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Funding

No financial support was necessary for this study.

Author information

Authors and Affiliations

  1. Clinical Department of Surgery, “Constantin Papilian” Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania

    Mihai Toma, Valentin Oprea, Ovidiu Grad & Carmen E. Bucuri

  2. “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania

    Mihai Toma, Mircea Gherghinescu & Calin Molnar

  3. “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania

    Valentin Oprea, Ovidiu Grad, Carmen E. Bucuri & Octavian Andercou

  4. Sigma Statistical Services, Balmullo, UK

    Harry Staines

  5. Second Clinical Department of Surgery, Emergency Clinical County Hospital, Cluj-Napoca-Napoca, Romania

    Octavian Andercou

  6. First Clinical Department of Surgery, Emergency Clinical County Hospital, Targu-Mures, Romania

    Mircea Gherghinescu & Calin Molnar

Authors
  1. Mihai Toma
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  2. Valentin Oprea
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  7. Mircea Gherghinescu
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  8. Calin Molnar
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Contributions

MT, VO, MG, CM: surgical procedures database, study conception and design, acquisition, analysis and interpretation of data, drafting the work and revising, final approval of the version to be published; HS: statistical analysis and interpretation of data, final approval of the version to be published; OA, CEB, and OG: drafting the paper and final approval of the version to be published;

Corresponding author

Correspondence to Valentin Oprea.

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Conflict of interest

All authors declare no conflict of interest.

Ethical approval

All procedures performed in this study 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.

Human and animal rights

No animal was used for this study.

Informed consent

Informed written consent was obtained from all patients before surgery.

Thanks

Special thanks to Helen Staines at plotsRdata.com for producing the figures.

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

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