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Impact of perforator sparing on anterior component separation outcomes in open abdominal wall reconstruction

  • 2020 SAGES Oral
  • Published:
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Abstract

Introduction

Anterior component separation (ACS) is a well-established, highly functional technique to achieve fascial closure in complex abdominal wall reconstruction (AWR). Unfortunately, ACS is also associated with an increased risk of wound complications. Perforator sparing ACS (PS-ACS) has more recently been introduced to maintain the subcutaneous perforators derived from the deep epigastric vessels. The aim of this study is to evaluate wound-related outcomes in patients undergoing open AWR after implementation of a PS-ACS technique.

Methods

A prospectively collected database were queried for patients who underwent open AWR and an ACS from 2006 to 2018. Patients who underwent PS-ACS were compared to patients undergoing ACS using standard statistical methods. Patients undergoing concomitant panniculectomy were included in the standard ACS group.

Results

In total, 252 patients underwent ACS, with 24 (9.5%) undergoing PS-ACS. Age and specific comorbidities were similar between groups (all p > 0.05) except for the PS-ACS groups having a higher rate of prior tobacco use (45.8% vs 19.6%, p = 0.003). Mean hernia defect area was 381.6 ± 267.0 cm2 with 64.3% recurrent hernias, and both were similar between groups (all p > 0.05). The PS-ACS group did have more complex wounds with more Ventral Hernia Working Group Grade 3 and 4 hernias (p = 0.04). OR time and length of stay were similar between groups (all p > 0.05). Despite increased complexity, wound complication rates were much lower in the PS-ACS group (20.8% vs 46.1%, p = 0.02), and all specific wound complications were lower but not statistically different. Hernia recurrence rate was similar between PS-ACS and ACS groups (4.2% vs 7.0%, p > 0.99) with mean follow-up of 27.7 ± 26.9 months.

Conclusions

In complex AWR, preservation of the deep epigastric perforating vessels during ACS significantly lowers the rates of wound complications, despite its performance in more complex patients with an increased risk of infection. PS-ACS should be performed preferentially over a standard ACS whenever possible.

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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. Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA

    Sharbel A. Elhage, Matthew N. Marturano, Tanushree Prasad, Paul D. Colavita, Kent W. Kercher, Vedra A. Augenstein & B. Todd Heniford

Authors
  1. Sharbel A. Elhage
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  2. Matthew N. Marturano
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  3. Tanushree Prasad
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  4. Paul D. Colavita
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  6. Vedra A. Augenstein
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  7. B. Todd Heniford
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Correspondence to B. Todd Heniford.

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Disclosures

Dr. Heniford has been awarded education grants and received honoraria from W.L. Gore and Allergan. Dr. Augenstein has received honoraria for speaking for Medtronic, Allergan, Intuitive, Acelity, and W.L. Gore. Dr. Colavita is a consultant for design of a research protocol for Becton Dickinson. Dr. Kercher has received honoraria for speaking for Bard and Ethicon. Dr. Elhage, Dr. Marturano, and Ms. Prasad have no potential conflicts of interest or financial ties to disclose.

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Elhage, S.A., Marturano, M.N., Prasad, T. et al. Impact of perforator sparing on anterior component separation outcomes in open abdominal wall reconstruction. Surg Endosc 35, 4624–4631 (2021). https://doi.org/10.1007/s00464-020-07888-8

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  • DOI: https://doi.org/10.1007/s00464-020-07888-8

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