2008 Annual Meeting Abstracts

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PURPOSE
The purpose of the study is to evaluate the use of component separation(CS) as a practical option for complicated ventral hernia repair. We hypothesize that CS can provide adequate repair for ventral hernias that are recurrent, resultant of infection, or present in complex patients. To date, most studies have reported on a small series of patients(<50 patients) with varied results in terms of postoperative complications and recurrence rates. The goal of the study is to evaluate the experience at a single tertiary care center with CS in complicated ventral hernia repairs and to gain insight on recurrence and other postoperative complications over a 9 year period.
METHODS
A list of patients who underwent a CS(ICD-9 code 15734) between April, 1997 and June , 2006 was obtained. The records of each patient were reviewed for demographic data, presence of comorbidities, indication for repair, size of defect, recurrence, and postoperative complications. Standard statistical tests (Student t , Chi square) were used to determine the factors associated with recurrence and wound infection/dehiscence. Logistic regression analysis was performed to assess for positive and negative predictors for recurrence and wound infection/dehiscence.
RESULTS
A total of 218 patients underwent a CS during the study period by 13 general and plastic surgeons. Age ranged from 20-82 years(mean 58); 117(54%) patients were male. Diabetes was present in 117(54%) patients; 113(58%) were obese(BMI >= 30). Nearly half(46%) of the cohort were active smokers. Out of 218 total patients, 162 underwent a CS for an initial hernia-37% for reasons related to an immunocompromised state (e.g., cancer, steroids, Crohns disease), 33% for no predisposing factors, 18% due to an concomitant ostomy or fistula takedown, and 12% for other infection sites. Fifty-six recurrent hernias were fixed using CS-59% for no other factors besides recurrence, 30% due to infected mesh, 7% related to other infections and 3% due to ostomy or fistula. Mesh was utilized in 68(32%) patients. Follow up ranged from 1-92 months(mean 14.4 months). Seven patients were followed for 5 years with no evidence of recurrence. Recurrence and wound infection were the two most common postoperative complications-68 patients(32%) and 56 patients(21%), respectively. Other complications included seroma(11%), skin dehiscence(9%) and hematoma(5%). In univariate analysis for recurrence, age>60 yrs(odds ratio 0.6, 95% CI (0.3, 1.0), p=0.05) and male sex(OR 0.6 (0.32, 1.0), p=0.06) demonstrated a protective effect on recurrence whereas immunosuppression(OR 2.1 (0.91, 4.8), p=0.08) tended to increase chance of recurrence. Only age>60 yrs and male sex proved to be a negative predictor for recurrence in a multivariate model. In univariate analysis for wound infection/dehiscence, active smoking (OR 2.2 (1.1, 4.3), p=0.02), obesity(OR 2.0 (1.1, 4.0), p=0.03), male sex(OR 1.8 (1.0, 3.3), p=0.05), prior recurrence(OR 2.7 (1.4, 5.2), p=0.002) and infected mesh(OR 4.1 (1.5,11.3), p=0.007) appeared to be significant positive predictors. In multivariate analysis, only male sex and smoking remained in the model.
CONCLUSIONS
Component separation is a viable alternative for repair of complex initial or recurrent ventral hernias with recurrence and wound infection as the two most common postoperative complications.

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