Evaluation of the Component Separation Technique for Treatment of Patients with Large Incisional Hernia

Abstract

Background: Incisional hernia remains a frequent complication of abdominal surgery. Results of surgical repair are disappointing with recurrence rates of suture repair being in the range of 5–63% depending upon the type of repair used, with better results using mesh implantation. In extreme cases a large hernial defect exists with a “loss of abdominal domain”. In addition, the approximated rectus muscles under tension become hypoper fused leading to atrophy and increased chances of recurrence. For the management of such large hernias, interest has been generated in the “ Component Separation Technique ”. This technique relaxes abdominal wall by translation of muscular layers without severing the innervation and blood supply, with or without the mesh augmentation. This can accommodate for defects up to 25–30cm in the waistline. However, wound complications are frequent and reported in up to half of the patients. Thus, the study was planned in view of the potential benefits of “CST” and its capability to restore lost abdominal domain. Methods: The study was conducted on 20 patients with “Large Incisional Hernia” with defect size >5cm or with a surface area >50cm 2 operated upon with component separation. Outcome was measured over a follow up period of three months in terms of recurrence and other local complications. Result: There were 20 patients [3 men and 17 women; 70% cases above the age of 50years]. Mean defect size was 9.5cm [range = 6–20cm]. Average body mass index was 28.97kg/m 2 [range = 22–37kg/ m 2 ]. Mean duration of hospital stay was 9 days [range = 5–21 days]. Early complications occurred in 15% (3/20) cases and post-operative abdominal compartment or recurrence was not reported over a follow up period of 3 months. Conclusions: It is finally concluded that “Large Incisional Hernias” can be effectively treated by “Component Separation Technique”