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Outcomes of complex abdominal wall reconstruction in patients with connective tissue disorders: a single center experience

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Abstract

Introduction

Individuals diagnosed with connective tissue disorders (CTD) are known to be predisposed to incisional hernia formation. However, there is a scarcity of data on outcomes for these patients undergoing hernia repair. We sought to describe our outcomes in performing abdominal wall reconstructions in these complex patients.

Methods

Adult patients with CTD undergoing open, elective, posterior component separation with permanent synthetic mesh at our institution from January 2018 to October 2022 were queried from a prospectively collected database in the Abdominal Core Health Quality Collaborative. We evaluated 30-day wound morbidity, perioperative complications, long-term hernia recurrence, and patient-reported quality of life.

Results

Twelve patients were identified. Connective tissue disorders included Marfan’s n = 7 (58.3%), Loeys-Dietz syndrome n = 2 (16.7%), Systemic Lupus Erythematosus n = 2 (16.7%), and Scleroderma n = 1 (8.3%). Prior incisions included three midline laparotomies and nine thoracoabdominal, mean hernia width measured 14 cm, and 9 were recurrent hernias. Surgical site occurrences (SSOs) were observed in 25% of cases, and 16.7% necessitated procedural intervention. All twelve patients were available for long-term follow-up, with a mean of 34 (12–62) months. There were no instances of reoperation or mesh excision related to the TAR procedure. One patient developed a recurrence after having his mesh violated for repair of a new visceral aneurysm. Mean HerQLes scores at 1 year were 70 and 89 at ≥ 2 years; Mean scaled PROMIS scores were 30.7 at 1 year and 36.3 at ≥ 2 years.

Conclusion

Ventral hernia repair with TAR is feasible in patients with connective tissue disorder and can be a suitable alternative in patients with large complex hernias.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA

    N. Messer, A. S. Prabhu, B. T. Miller, D. M. Krpata, L. R. A. Beffa, C. C. Petro, S. M. Maskal, R. C. Ellis, S. Figueiredo, A. Fafaj & M. J. Rosen

  2. Department of Surgery, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel

    N. Messer

  3. The Abdominal Core Health Quality Collaborative, Centennial, CO, USA

    S. E. Phillips

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  1. N. Messer
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  2. A. S. Prabhu
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Correspondence to N. Messer.

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Conflict of interest

I declare that there are no conflicts of interest related to this manuscript. The study was conducted impartially, and the findings presented in the manuscript are based solely on the analysis and interpretation of the data.

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The research was conducted in accordance with the ethical principles outlined in Institutional Review Board. The use of data and materials was carried out with proper authorization and in compliance with all applicable laws and regulations.

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As this study involved the use of existing data and did not involve direct interaction with human subjects, no patients were enrolled, and therefore, no informed consent was required. The data used in this research were anonymized and de-identified, ensuring the privacy and confidentiality of individuals in accordance with the Institutional Review Board.

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In adherence to ethical standards, this chart review study, though devoid of direct human or animal involvement, maintained patient data confidentiality and ethical standards as required by the institutional review board.

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Messer, N., Prabhu, A.S., Miller, B.T. et al. Outcomes of complex abdominal wall reconstruction in patients with connective tissue disorders: a single center experience. Hernia (2024). https://doi.org/10.1007/s10029-023-02957-y

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