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A meta-analysis comparing open anterior component separation with posterior component separation and transversus abdominis release in the repair of midline ventral hernias

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Abstract

Purpose

This study aims to compare the outcomes of posterior component separation and transversus abdominis release (PCSTAR) with the open anterior component separation (OACS) technique. OACS, first described by Ramirez et al. (Plast Reconstr Surg 86(3):519–526, 1990), has become an established technique for local myofascial advancement in abdominal hernia surgery. PCSTAR, described by Novitsky et al. (Am J Surg 204(5):709–716, 2012), is being used more frequently and is rapidly becoming the technique of choice in complex ventral hernia repair.

Methods

Analysis was conducted according to PRISMA guidelines. A systematic search of the MEDLINE, EMBASE and Pubmed databases was performed. Studies reporting exclusively on midline ventral hernia repair were reviewed. Studies describing PCSTAR were selected and compared to matched studies describing OACS. Meta-analysis was used to compare outcomes between the two-pooled groups.

Results

Seven studies describing 281 cases of PCSTAR for midline incisional hernia using a retromuscular mesh placement were identified. Six comparable studies describing 285 cases of OACS and retromuscular mesh placement were identified from the same search. Pooled analysis demonstrated a hernia recurrence rate of 5.7% (3.0–8.5) for PCSTAR and 9.5% (4.0–14.9) for OACS. Comparative analysis demonstrated no significant difference between hernia recurrence rate (p = 0.23). The use of bridging mesh was not significantly reduced by the use of PCSTAR (3.1%) when compared to ACS (7.5%) (p = 0.22). No significant difference was found in wound complication rates between PCSTAR and OACS, respectively, ‘superficial’ 10.9 vs 21.6% (p = 0.15); and ‘deep’ 9.5 vs 12.7% (p = 0.53).

Conclusions

These data suggest PCSTAR have comparable outcomes to OACS. This analysis is limited by the lack of comparative studies and heterogenicity in the OACS group.

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Funding

Nil related to current review.

Author information

Authors and Affiliations

  1. St Mark’s Hospital and Academic Institute, Watford Road, Harrow, London, HA1 3UJ, UK

    J. D. Hodgkinson, C. A. Leo, Y. Maeda, S. M. Oke, C. J. Vaizey & J. Warusavitarne

  2. Department of Surgery and Cancer, 10th Floor, QEQM Building, St Mary’s Campus, Imperial College, Praed Street, Paddington, London, W2 1NY, UK

    J. D. Hodgkinson, C. A. Leo, S. M. Oke, C. J. Vaizey & J. Warusavitarne

  3. Stats Consultancy, Amersham, UK

    P. Bassett

Authors
  1. J. D. Hodgkinson
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  2. C. A. Leo
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  3. Y. Maeda
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  4. P. Bassett
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  5. S. M. Oke
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  6. C. J. Vaizey
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  7. J. Warusavitarne
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Contributions

Jonathan Hodgkinson helped design the study, acquired and interpreted the data, drafted and approved the final manuscript; Cosimo Leo helped acquire and interpret the data, drafted and approved the final manuscript; Yasuko Maeda interpreted the data, drafted and approved the final manuscript; Paul Bassett and Siddhartha Oke helped interpret the data, drafted and approved the final manuscript; Carolynne Vaizey contributed to the study design and concept, revised the critically important intellectual content and approved the final manuscript; Janinadra Warusavitarne contributed to the study design and concept, revised the critically important intellectual content and approved the final manuscript.

Corresponding author

Correspondence to J. D. Hodgkinson.

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Conflict of interest

JDH declares no conflict of interest; CAL declares no conflict of interest; YM declares no conflict of interest related to the submitted work and declares personal fees from Medtronic and Astellas; PB declares no conflict of interest; SO declares no conflict of interest; CV declares no conflict of interest directly related to the current work and declares consultancy advisor to Acelity and paid lecture for Allergan; JW declares no conflict of interest.

Ethical approval

This study did not need approval from an ethic committee.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was not required for this type of study.

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Hodgkinson, J.D., Leo, C.A., Maeda, Y. et al. A meta-analysis comparing open anterior component separation with posterior component separation and transversus abdominis release in the repair of midline ventral hernias. Hernia 22, 617–626 (2018). https://doi.org/10.1007/s10029-018-1757-5

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  • DOI: https://doi.org/10.1007/s10029-018-1757-5

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