Repair of giant incisional hernias: Comparison of separation technique with and without mesh

BACKGROUND: Incisional hernias are one of the most common postoperative complications encountered by surgeons in daily practice. In our study, we compared the component separation technique (CST) with and without synthetic mesh in large incisional hernia surgery. MATERIALS AND METHODS: The files of 79 patients who underwent surgery for giant incisional hernia between January 2016 and November 2020 were reviewed retrospectively. The patients were divided into two groups: CST with mesh reinforcement (mesh+ group) and CST without mesh reinforcement (non-mesh group). The groups were compared in terms of recurrence, complications, and other clinical features. RESULTS: There were 36 patients in the mesh+ group and 38 patients in the non-mesh group. There was no significant difference between the two groups in terms of demographic parameters and clinical features. There was a statistically significant difference between the groups in terms of recurrence rate (P = 0.007, OR = 0.17). In addition, there was a significant difference between the two groups in terms of mean operation times (2.8 h and 1.9 h for mesh+ and non-mesh, respectively) (P = 0.000, 95% CI). Regardless of the use of mesh, recurrence was significantly higher in the presence of high body mass index (BMI) (P = 0.003, 95% CI) and comorbidity (P = 0.031, OR = 3.4). CONCLUSION: Repair of giant incisional hernias with mesh-reinforced CST is superior to the non-mesh technique in terms of hernia recurrence. Although CST without mesh reinforcement seems advantageous in terms of complications and operation time, we believe that the mesh-reinforced CST should be applied in suitable patients when the total cost, recurrence, and patient satisfaction are taken into account.